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HomeMy WebLinkAboutBUSINESS PLAN 5/15/2008 Per it Operate - LOCATION: - Issued by: to Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This oermit is issued for the following: It! Hazardous Materials Plan o Underground Storage of Hazardous Materials o Risk Management Program o Hazardous Waste On~Slte Treatment CA 93309 Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., 3rd Floor Approved by: Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: June 30, 2003 "- .~ -~ ..,. fL- .,1yCloC\ ,.~ ~ y\ ¥I~ ~, ',,,," , 1- S>1' ø' ,\ " \ / , // ~/ - . fÒ¿ù~~ ~\a~ro.«\ -rQ~ j\~obert Osborn, DDS . - r::-, ~ EMERGENCV/(1~~of{ t:-G.$ EXIT Consultation Consultation Room Room ,1. __~ Consultation Room .8 Dark ¡::jitr 'ì R~,", Reception Room r~ EMERGENCY EXIT, No~~ ~ Haz Waste l"~ Eve Wash Station .... . X Sterilizer ©Satèty Compliance Services (818) 552-2114 Business Room Doctor's Office . . Fire Extinguisher Smoke Detector 1·" F ire Alarm *,Y'f\~i" w~ .~~, ~ . o Operatory ~ Opera to I)' t'rI . š' if_ £:J.êé.}rcci) SS. ~.¡,,¡,,~ oÇ¡:; R . /r--~\. (~estro;¡f r;{r J~, ""/ frilization -¡. '\Àrea .... '- ~, '\"\, Operatory SOl..1'Ì''v) Lounge Area ~o ¡::-,JtCI1" 'p.;. r~,%U~ \ 0 2. W~.1r [! First Aid Kit ø Spill Kit . Emergency Kit 1ft Safety Manual ~ MSDS Manual X-Ray o Water Fountain * Medication o Sprinkler -\-h.,.o......~~ cv.A' ~II\-\-:..c.... öCç c..A-> OSB~RN DDS INC G ROBERT SiteID: 015-021-002133 Manager STEPHANIE CRAVEN Location: 4260 TRUXTUN AVE 150 City BAKERSFIELD . BusPhone: (661) 322-9885 Map 102 CommHaz High Grid: 25C FacUnits: 1 AOV: CommCode: BFD STA O1 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title STEPHANIE CRAVEN / OFFICE MANAGER GWEN MOSS / OSHA COORD Business Phone: (661) 322-9885x Business Phone: (661) 322-9885x 24-Hour Phone (661) 324-OOlOx 24-Hour Phone (661) 399-1359x Pager Phone ( ) - x Pager Phone (661) 319-7875x Hazmat Hazards: Fire Press React ImmHlth DelHlth Contact GWEN MOSS Phone: (661) 322-9885x MailAddr: 4260 TRUXTUN AVE 150 State: CA City BAKERSFIELD Zip 93309 Owner G ROBERT OSBORN DDS Phone: (661) 398-9080x Address 4260 TRUXTUN AVE 150 State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif ~ d: RSs : No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN EIVr~ r ~~ Cased cn my inquiry of those indivic?ua~s i res on ibl f bt i 2 ~~07 p s e or o a n ng the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, urat , a, d complete. $~(~ "'-'~'" gi ature Date -1- 02/05/2007 ;, F OSBbRN DDS INC G ROBERT SiteID: 015-021-002133 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE F P IH G 250.00 FT3 Hi OXYGEN F IH DH G 502.00 FT3 Low WASTE FIXER R L 5.00 GAL Min DIESEL, EMERG. GEN. FUEL L 55.00 GAL UnR -2- 02/05j2007 -3- 02/05/2007 F OSBORN DDS INC G ROBERT ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME NITROUS OXIDE Location within this Facility Unit UTILITY ROOM SiteID: 015-021-002133 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 10024-97-2 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 250.00 FT3 250.00 FT3 250.00 FT3 tit~~rjtcLVUS wlnrViv~lvl5 %Wt. RS CAS# 100.00 Nitrous Oxide No 10024972 t1AGKKIJ A~~L~Sa1~1~1V'1'S TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: UTILITY ROOM CAS# 7782-44-7 STATE T TYPE PRESSURE ~~ TEMPERATURE ~~ CONTAINER TYPE ~ ~Gs.S I Pure Above Ambient I Ambient I PORT_ PRESS. CYLINDER I AMOUNTS AT THIS LOCATION Largest Co251100rFT3 Daily 502100m FT3 I Daily 251r00e FT3 riEiGEiCtLVUA LV1~lYV1VL"1V1J ~Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 ri.'iGEiiCL E~~ ~I;JJ1~11~;1V 1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -4- 02/05/2007 F OSBORN DDS INC G ROBERT SiteID: 015-021-002133 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: X-RAY ROOM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Waste Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL L1HL,riRLlV U.7 l,Vllt'V1V P~1V 1.7 %Wt• RS CAS# Silver No 7440224 i1tiGK[CL H,J .7.G.7J1~11=,1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME DIESEL, EMERG. GEN. FUEL Days On Site 365 Location within this Facility Unit Map: Grid: CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient OTHER - SPECIFY AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 55.00 GAL HAZARDOUS COMPONENTS ~ , %Wt RS CAS# HAZARD A SSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UnR -5- 02/05/2007 t• F OSBORN DDS INC G ROBERT SiteID: 015-021-002133 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 10/17/2006 ~ FIXER IS CONTAINED IN A PLASTIC 5-GAL CONTAINER WHICH HAS SECONDARY CONTAINMENT UNDER IT. WHEN 5-GAL CONTAINER IS FULL WE CONTACT JIM WARREN TO REMOVE AND DISPOSE. Employee Notif./Evacuation 03/15/2006 CONTACT GWEN MOSS OR DR OSBORN BY CALLING 24-HR ANSWERING SERVICE AT 322-9885. Public Notif./Evacuation GWEN MOSS WILL TAKE CARE OF CALLING ANY AUTHORITIES. SURE ALL IS TAKEN CARE OF. 10/17/2006 DR OSBORN WILL MAKE Emergency Medical Plan 10/17/2006 WE HAVE EVACUATION PLAN IF NEEDED, MEETING PLACES, PERSON TO REPORT TO. WE HAVE A MEDICAL DOCTOR TO SEE IF ANY ACCIDENTS OCCUR, DR DAVE DOUGHERTY. -.6- 02/05/2007 F OSBORN DDS INC G ROBERT SiteID: 015-021-002133 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 10/17/2006 ~ OXYGEN IS STORED WITH CHAIN AROUND IT TO PREVENT IT FROM FALLING OVER AND IT IS TURNED ON AND OFF EACH DAY. NITROUS OXIDE IS STORED WITH CHAIN AROUND IT TO PREVENT IT FROM FALLING OVER AND IT IS TURNED ON AND OFF EACH DAY. SCAVENGER SYSTEM IS USED TO REMOVE ANY UNUSED PORTION DURING OPERATION. FIXER IS CONTAINED IN 5-GAL CONTAINER AND SECONDARY CONTAINER AND REMOVED BY JIM WARREN. GENERATOR. Release Containment Clean Up 10/17/2006 ALL EMPLOYEES WILL REFER TO THE MSDS MANUAL AND FOLLOW APPROPRIATE PROTOCAL. JIM WARREN REMOVES WASTE FIXER AS NEEDED. -7- 02/05/2007 F OSBORN DDS INC G ROBERT SiteID: 015-021-002133 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~,_ V 1.1161 .RGe7V UlVG t]1. 1.1VQl.1 Vll -8- 02/05/2007 s+ F OSBORN DDS INC G ROBERT SiteID: 015-021-002133 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~J~JCC:1d1 Ild'Gd.i. US Utility Shut-Offs 10/17/2006 A) GAS - E SIDE OF BLDG NEXT TO EXIT DOOR B) ELECTRICAL - E SIDE OF BLDG ELECT RM C) WATER - E SIDE OF BLDG D) SPECIAL - NONE E} LOCK BOX - NO Fire Protec./Avail. Water 02/05/2007 PRIVATE FIRE PROTECTION - SPRINKLERS IN OFFICE, FIRE EXTINGUISHERS, AND ALARM SYSTEM. NEAREST FIRE HYDRANT - FRONT OF OFFICE. Building Occupancy Level 02/28/2006 7 EMPLOYEES -9- 02/05/2007 ,' a F O5BORN DDS INC G ROBERT SiteID: 015-021-002133 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 10/17j2006 ~ MSDS SHEETS ON FILE. BRIEF SUMMAFZY OF TRAINING PROGRAM: YEARLY TRAINING IS PROVIDED FOR ALL EMPLOYEES. WE OFFER TRAINING IN INJURY & ILLNESS PREVENTION, HAZARD COMMUNICATIONS, EXPOSURE CONTROL AND EMERGENCY ACTION PLANS. rayc ~ ncl.u ivl. ru~uic vac Held for Future Use -10- 02/05/2007 .;~ ^~ LOCATION OF EMERGENCY SHUTOFFS ~1 SERVICE SHUT OFF LOCATION Medical Gas Shut Off Medical Gas Co. - 631-5170 Location: Medical Gas Closet, located in the back exit hallway. Key to gas closet is in first cabinet on left in Scope Room. To shut off, turn 4 white levers 90 degrees. Water Shut Off Water Co. - 396-2400 Location: east side of the building on the outside. Need key to unlock pipe room. Key to pipe room is in first cabinet on left in Scope Room. To shut off, locate pipe labeled #120, turn white lever 90 degrees. Call Water Co. at number above. Electrical Shut Off Electrical Power Co. - 1-800-743-5000 Location: Electrical Closet in A&D room. Call Electrical Power Co. or 911 for shut off. Administration offfice: Panel is in storage room. Fire/Sprinkler Shut Off Shut off must be done by Bakersfield City Fire Department. Ca11911 or 324-4542. Generator Pacific Power - 327-7377 C EMERGENCY SYSTEMS AVAILABLE 1N THIS FACILITY FIRE ALARM SYSTEM 1. This alerts personnel and notifies the Fire Department: a. Directly or indirectly through Secure Alarm (326-1747, 1-800-458-4519) b. Prior to, and after any test or actual alarm, the above Agency must be notified by telephone. This procedure alerts the concerned Agency of an impending receipt of an alarm due to testing or verification of an actual alarm and the reporting of meaningful information. FIRE AND/OR SMOKE BARRIER DOORS 'i These doors divide the facility into sections to prevent the spread of fire and/or smoke. 2. All doors shall be regulazly maintained and kept in an operative condition and shall not be obstructed at any time. SMOKE AND HEAT DETECTORS 1. Smoke Detector: A device which detects the visible or invisible particles of combustion. Types most commonly used: a. Ionization (smoke detection principle) b. Photoelectric (light obscuration and smoke detection principle) (At TSC) 2. Heat Detector: A device which detects abnormally high temperature or Rate-of--Rise. Types most commonly used: a. Non-restorable detector The sensing device is destroyed during detection process. b. Restorable detector The sensing device is not ordinarily destroyed during detection process. Manual or automatic restoration. c. Self-restoring detector (At TSC) The sensing device returns to normal automatically. (Need to check the fire panel in front office; is reprogram need so detector will restore itself) EMERGENCY LIGHTING AND POWER SYSTEM _. L. S'~prauide_automatic~estoration 9f nowe~r emergency circuits within FIVE SECONDS after normal power failure. Flashlights shall be ready to use (batteries fully charged) at all times. Open flame type of light (candles) shall not be used. The following services are powered by the emergency power source: a. Exit lights b. Emergency "Call" system c. Fire alarm system d. Fire and/or smoke barrier doors (no power source involved) e: Hallway lights (every third light fixture) f. Electrical outlets (usually colored red) 0 i~ PLAN FOR SECURITY EMERGENCIES In the event of an intruder to the Center or an unruly patient, the following procedures will be used: - -~ntrader~t~Offi~ : - Try to contain intruder to the lobby azea Call 911 and notify of situation. Nurse move patients and family members in lobby area to A&D Area. Use telephone in A&D Room as needed to phone for assistance. If possible evacuate suite using back exit. Do not cross in front of the entrance to office suite. Or; Nurse move patients and family members in A&D area to Pt. waiting room. Use telephone in waiting room to phone for assistance. If possible, evacuate from suite using back entrance in suite. Do not cross back in front of main office entrance. If procedure is in progress, follow instructions of Medical Director to maintain sterile procedures. ~~ Office staff assist in moving patients as needed and maintain contact with 911 Unruly patient: If the patient is in main lobby, lock the connecting door to suite. Remove any patients and family members in suite to back exit if it appears necessary. (Use above instructions) If patient is in the office suite or restroom, remove other patients and family members to main lobby and then out of suite by front door. Call 911 and notify of situation. Try to determine the cause of the patient's upset and have an appropriate member of the staff try to calm and reason with patient (i.e. physician, administrator, etc. depending on nature of upset). Wait for emergency assistance. FIRE AND DISASTER PROCEDURES FIRE PROCEDURE 1. In the event that the fire alarm goes off, or there is a fire in the facility, the following steps should be instituted: - ACTIVATE THE CLOSEST PULL BOX - Call the Fire Department (911) - Receptionist announces "Code Red" and location. - Shut off oxygen at emergency shut-off - If the fire is containable, the fire extinguisher at Receptionist's hallway shall be activated and used on the fire. 2. The Center staff will usher all ambulatory patients out the nearest available exit and to a safe area in a calm an orderly manner. It will be the responsibility of the staff to make sure all patients are out of the area. The administrator will oversee evacuation and will "~ be the last to leave the building. ~, No patient shall be left unattended. Staff shall remain with patients to assure patient safety and accountability. 3. If procedure is in progress and can be brought to an interim conclusion safely, it should be done so as soon as possible. A sterile dressing should be applied to the patient's wound, and the patient moved to the nearest exit. 4. In the event of heavy smoke, cover face with wet cloth, drop to floor and crawl to safest area exit. 5. In no event should an attempt be made to contain the fire prior to calling the Fire Department and activating the fire alarm. c~ 5' EARTHQUAKE Earthquakes can be a frightening event. Every effort needs to be made to comfort, reassure and protect persons from injury. 1. WHEN A NOTICEABLE EARTHQUAKE TAKES PLACE: a. Personnel should protect themselves from falling objects. (Fixtures, plaster, etc.} b. It is best to lie face down on the floor next to an interior wall. c. Place your hands over your head for protection. d. DO NOT RUN OUTDOORS! You maybe hit by falling debris or electrical wires. ~..~ 2. WHEN INITIAL QUAKE STOPS: a. Personnel should make an immediate check of all persons and report any injuries or damage to the Medical Director. Administer First Aid as necessary. b. If necessary, remove the injured or those in dangerous areas. c. Make a check of the facility for any of the following: - Fires - Doors not openable - Weakness of walls or ceilings - Broken glass or spilled liquids - Electrical shorting or power failures - Ruptured gas or water lines. d. Close all drapes or curtains. This will protect room occupants from the danger of falling glass during after shocks. Leave all undamaged rooms doors open. e. Make every effort to calm persons' fears and keep them away from large windows, skylights and overhead lighting fixtures. 0 Earthquake Page 2 of 2 f. Turn on portable battery operated radio for knowledge of extent damage. Car radio or C.B. unit may be available. g. Flashlights and spare batteries should be provided h. Notify Fire, Police and any other necessary Governmental Agencies for assistance. (Fire or Police - 91 I ) i. Notify off duty personnel. j. Make every effort to carry out routine procedures and return facility to normal operations. 3. EVACUATION: Should the facility be damaged severely enough to require evacuation: a. Medical Director shall make the determination of when to evacuate from an unsafe to a safe area. r"-~~ ~~•--~~' b. Evacuation should only be attempted when you are certain that the area chosen for the evacuees is safer than the area you are leaving. --- BE PREPARED FOR AFTERSHOCKS --- They could be large enough to cause further extensive damage. I~ R DISRUPTION OF SERVICE 1. WATER a. NOTIFY THE MEDICAL DIRECTOR b. Notify the water company ,(396-2400). Water shutoff location: East side of the building, inside the small room, key needed to unlock room, pipe labeled #120. c. Immediately restrict the use of water. If there is a possibility of contamination, turn off the Main Water Valve. d. Deliver adequate drinking water to each designated area. e. Consider the possibility of recovering and storing water from toilet tanks, water heaters, and boilers. f. Inform personnel to be prepared to line the toilets with plastic bags for the removal of human waste. Plastic bags should then be considered Infectious Waste. ,~, 2. MEDICAL GAS a. NOTIFY THE MEDICAL DIRECTOR. b. Notify the Medical Gas Company (631-5170). Medical gas shutoff location: Medical Gas closet in the back exit hallway. c. If a gas leak is evident, notify the Fire Department. d. Remove occupants and open door and windows to ventilate. 4 e. Shut off Local Valve or Main Valve at meter. f. Do not use matches, candles or other open flame devices or activate light switches or other electrical appliances. 3. ELECTRICITY a. NOTIFY THE MEDICAL DIRECTOR. b. Notify the Power Company (1-800-743-5000) Main power panel location: Electrical room off the doctor's dictation station. i .. ~ FLOODING 1. CAUSES OF FLOODING: a. Broken Water Main b. Excessive Rain c. Broken Dam or Reservoir 2. AT TIME OF FLOODING SITUATION: a. Shut OFF all utilities. b. Activate any subterranean pump to remove water. c. Toilets can be removed from floor to provide a readily available drain, particularly in multi-storied facilities. d. NOTIFY: ~ Administrator -'~ - Fire Department - Police Department - Civil Defense e. PROVIDE: - Transportation - Blankets - Medication - Sand Bags , - Shovels f. Make every effort to provide for persons' needs. 3. EVACUATION: a. Flooding usually requires the moving of persons to another location of a higher elevation. b. Secure the facility and leave the building if it becomes necessary. i Flooding Page 2 of 2 c. Administrator shall make the determination of when to evacuate from an unsafe to a safe area. d. Evacuation should only be attempted when you are certain that the area chosen for the evacuees is safer than the area you are leaving. `~__.~~ 0 ~, WINDSTORM 1. IF A WIl~TDSTORM SHOULD OCCUR: a. Move all persons inside to a safe location. Interior corridors, bathrooms without windows are the safest areas in a facility. b. Secure all outdoor furniture, trash cans, etc. c. Board up all outside windows, if time permits. d. Keep radio and/or T.V. on. (Listen for weather advisories). e. Provide snack f. Provide flashlights. g. Remember -fires during windstorms are extremely dangerous! 2. EVACUATION: a. Evacuation during windstorms should not usually be attempted. ( ~` ~ ~- b. Administrator shall make the determination of when to evacuate from an unsafe to a safe area. c. Evacuation should only be attempted when you are certain that the area chosen for the evacuees is safer than the area you are leaving. io BOMB THREAT 1. QUESTIONS TO ASK THE CALLER a. WHO is calling? b. WHERE is the BOMB right now? c. WHAT does the BOMB look like? d. WHEN is the BOMB going to explode? e. WHY are you trying to harm others? 2. WHAT TO DO a. KEEP THE CALLER TALKING b. ATTRACT ATTENTION of nearby person to call the POLICE. c. SECURE FACILITY from unauthorized persons. ~ ~~ ---d- ; ~ NOTIFY THE MEDICAL DIRECTOR. . 3. QUICK SEARCH: a. Initiate a thorough search. b. Check the following: - Closets - Cupboards - Toilet Tanks - Lockers - Storage Rooms c. Check all rooms accessible to the public. - Public restrooms - Utility area d. Nursing personnel shall be responsible for: - Emergency power room ' - Medical oxygen storage area. i Bomb Threat ' Page 2 of 2 e. Search outside grounds: - Shrubbery - Roof CAUTION: DO NOT TOUCH OR MOVE THE OBJECT! 4. IF "SUSPECTED OBJECT"IS FOUND: a. ANNOUNCE or CALL OUT - "CODE TRIAGE". Emergency "Call" System should be used as a means of notification. b. DO NOT ACTIVATE THE FIRE ALARM SYSTEM. c. .Evacuate all persons to a safe area - a minimum of three (3) walls in each direction away from the device. (r-~~ `~----~ 5. SECURE THE FACILITY: a. Remove patients from hallways. b. Close all doors leading into the hallway. c. Close all Fire and/or Smoke Barrier doors. This will provide protection from the force of any explosion. 6. IF EVACUATION IS INITIATED: a. The decision to evacuate is the responsibility of the Medical Director. 7. RE-ENTRY INTO THE FACILITY: a. DO NOT ALLOW RE-ENTRY INTO THE FACILITY UNTIL AUTHORIZED. i EVACUATION ,~ DEFIl~TITION Evacuation is the removal of persons either horizontally or vertically from a dangerous or potentially dangerous area to one of safety. The need to move persons to the outside is determined by the seriousness of the emergency. In most cases, areas of safety within the facility are created by the closing of all doors opening into hallways and all fire and/or smoke barrier doors. 1. Types of Evacuation a. Partial This is the removal of persons (where a Fire or other Emergency can be confined to one room) to a safe location. If necessary, be prepared to move persons from adjoining areas. b. Horizontal This is the removal of persons on a horizontal plane. If necessary, be prepared to move persons to another area of the Center and possibly to the ~. --' outside. c. Complete This is the removal of all persons to a place of safety outside the Facility. 2. WHY EVACUATE? a. To move people from to safe areas. Evacuate only when you are certain that the area chosen is safer than the area you are leaving. b. To free the use of the facility for the care of incoming casualties or displaced persons. c. Administrator shall make the determination of when to evacuate. CJ Evacuation ~ Page 2 of 2 3. WHEN EVACUATION IS NECESSARY: a. Priority of evacuation is based on the exposure to danger. b. Notify the receptionist that evacuation is taking place. c. Lead ambulatory patients from the area by the nearest, safest exit. Other patients shall be moved by wheelchair or stretcher. d. The Physician is responsible for the safety of the patient in the Procedure Room. The endoscopy team will remain under his control. A&D room patients are the responsibility of the Nursing Director/Administrator. e. Try not to exit the same way the Fire Dept. will enter. f. Make a final search to make sure all patients and staff have been evacuated. _~ ~:'~ 4. WI-~RE TO EVACUATE ~_.. . a. To an area outside the facility: - Parking lot - To nearby Hospital - To other Facilities or Buildings in the area DO NOT CROSS STREETS UNLESS ABSOLUTELY NECESSARY. 5. EVACUATION PRIORITIES First: Those in immediate danger Second: Ambulatory (A patient who is able to leave a building unassisted under emergency conditions.) Third: Non-ambulatory (A patient who is unable to leave a building unassisted I. - - i UNIFIED PROGRAM INSPECTION CHECKLIST.: SECTION 1: Business Plan and Inventory Program • I "'~ Prevention Services B r:_R_s F ~ n 900~'I ,Yu~tu~~ue„ Suite 210 P/RE B ersfield, CA 93 ARTM r el.: (661) 326-397 Fax: (6'1')-872'=2171 FACT TY M ~ INSPECTION DATE INSPECTION TIME ~ ADDRESS _ r _ PHONE NO. NO OF EMPLOYEES FACILITY CONT x 1 "~C S' BUSINESS ID NUMBER 15-021-UGZ.i33 ~S - ~~ ( --. y, Sec_ tion 1: Business Plan and Inventory Program ~ ~ ~J~~ ~ ~. J~ROUTINE ^ COMBINED- ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND BUSIIIeSS PLAN CONTACT INFORMATION ACCURATE ~.,L W e~~ t'~' S f~ ~3. t ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATIOMOF INVENTORY MATERIALS ^ t . VERIFICATION OF QUANTITIES ~ 1 n ~~~~ , ~ I [ ~~ ~J~11`.'C ' ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ~~ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ~ { / l/" ` ^ CONTAINERS PROPERLY LABELED ~' ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS Wq,STE O~ITE? ~ES ^ NO EXPLAIN: ~ ~ ~ ~`'7"Q~ ~ ~~ '~ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 i `~ `J Inspector (Please Print) Fire Prevention / 1s' In /Shift of Site/Station # / Business Site / RE White -Prevention Services ~ Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09105 . . CITY OF BAKERSFlEl..D FIRE DEPARTMENT OFFICE OF ENVIRONMENT AIL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., Jrd Hoor, Bakersfield, CA 93301 FACILITY NAME bl r¿ß~{)$6()þl po¡, INSPECTION DATE to/'JID} ADDRESS 42"0 Tl&xrv¡¡} . -:d-/5i PHONE NO, 32-2- - C¡8B~ FACILITY CONTACT 'ji/l1y5PjUA- BUSINESS 10 NO. 15-210- ;¿/~} INSPECTION TIME 1-;.) M ('\;I, NUMBER OF EMPLOYEES 5 Section I: Business Plan and Inventory Program Routine o Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERA nON c v COMMENTS App~opriate permit on hand Business plan contact information accurate ( , ¡J Visible address Correct occupancy ,¡ Verification of inventory materials ¡ Verification of quantities ./ Verification of location ,¡ Proper segregation of material V ./ Verification of MSDS availability V Verification of Haz Mat training if Verification of abatement supplies and procedures V ,/ ./ .. V Emergency procedures adequate Containers properly labeled / Housekeeping V Fire Protection V/ Site Diagram Adequate & On Hand / --~ ¡...---- - C-Comphance V=VlOlatlon White· Env. Svcs, Yellow - Stalion Copy Any haz~rctous waste.san site?: );( Yes 0 No Explain: j;ljjJ-rL /7>--¡::¡7'-- ..c:... Questions regarding this inspection? Please call us at (661) 326-3979 Pink· Business Copy 10 ~·i ~.", <r G ROBERT OSBORN DDS.C IL 'v SiteID: 015-021-002133 CommCode: BAKERSFIELD STATION 01 EPA Numb: \ 'L~'~ ~'ÜCò ,. BusPhone: Map : 102 Grid: 25C (661) 322-9885 CommHaz : Moderate FacUnits: 1 AOV: Manager : Location: 4260 TRUXTUN AVE 150 City BAKERSFIELD SIC Code: DunnBrad: Emergency Contact G ROBERT OSBORN Business Phone: 24-Hour Phone : Pager Phone / Title / DDS (661) 322-9885x (661) 322 - 9885x () x Emergency Contact / Title JUDY SPYRKA / OSHA COORD Business Phone: (661) 322-9885x 24-Hour Phone : (661) 322-9885x Pager Phone : () X Period to Preparer: Certif1d: ParcelNo: Fire Press React ImmHlth DelHlth Phone: (661) 322-9885x State: CA Zip 93309 Phone: (661) 322-9885x State: CA Zip 93309 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Hazmat Hazards: Contact : MailAddr: 4260 TRUXTUN AVE 150 City BAKERSFIELD Owner Address 4260 TRUXTUN AVE 150 City BAKERSFIELD Emergency Directives: ~.~ [DQ) hSf~~~ œúlt¡~n ~lf'¡~~ ~ Ik<S\QRJ6\ I' î1~ &7 $!!WIU!Qm0) U'if U U<Q¡ U \Ø f®~Û®~ QIfïJ@ ~~~©li1®1Q) 1fïJ~~M©~$ ~®UìJ~~$ m~~~@®o ~ S JJ1C/ . mooft [Q)~ifB ~©ú"G.· ();~lf\l P~fû©f QIfïJ®Q öft ®~©fñVõì wåiÛ1 ( ~ QU()ftt)OO) " "¡;;¡ my (OOW®©íÏö©ffD$ OOffD~aßft~Q® tã} oom!PJ~ft® m1Q1 ©@ú"ú"ooa m®!'i)- ~ ¡g~tã}!'i) ~©U' M~ ~©l@ÏijÒfty. .Ç~7~ -1- 08/13/2003 - , Î' ':- -; - - G ROBERT OSBORN DDS INC SiteID: 015-021-002133 Manager : Location: 4260 TRUXTUN AVE City BAKERSFIELD sPhone: (661) 322-9885 CommHaz : Moderate FacUnits: 1 AOV: CommCode: BAKERSFIELD EPA Numb: Emergency Contact / Title Emergency Contact / Title G ROBERT OSBORN / DDS / Business Phone: (661) 322-9885x Business Phone: ( ) - x 24-Hour Phone : ( \010 \ ) 9'2. - "~'ð? x ~=l 24-Hour Phone : ( ) - x Pager Phone : ( ) - x 2~ ~~s Pager Phone : ( ) - x Hazmat Hazards: Fire Press React ImmHltn DelHlth Contact : Phone: (661) 322-9885x MailAddr: 4260 TRUXTUN AVE 150 State: CA City : BAKERSFIELD Zip : 93309 Owner Phone: (661) 322-9885x Address : 4260 TRUXTUN AVE 150 State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: One Unified List ì All Materials at Site ì SpecHaz EPA Hazards DailyMax MCP F IH DH G 502.00 FT3 Low F P IH G 250.00 FT3 Hi R L 5.00 GAL Min F Hazmat Inventory p== As Designated Order Hazmat Common Name... OXYGEN NITROUS OXIDE WASTE FIXER I, _ "'-.L~~~~Ð) Do her~by certi~ that ~ havs reviewed the attached hazardous matsrials manage- ment plan 1orC1.í?o\Q.et'+ ~n and that i~ along with (NamÐOf~ any corrections consmute a complete and correct man- agement plan.for my facility. . 1- .~1~~~ \\\\\0\ OCto 12/04/2000 -;f.. <¡ e e F G ROBERT OSBORN DDS INC p= Inventory Item 0001 = COMMON NAME / CHEMI CAL NAME OXYGEN SiteID: 015-021-002133 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit INSIDE UTILITY ROOM Map: Grid: CAS # 7782-44-7 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 251. 00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 502.00 FT3 Daily Average 251.00 FT3 %Wt. - RS__ _ CAS# 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low HAZARD ASSESSMENTS p= Inventory Item 0002 = COMMON NAME / CHEMICAL NAME NITROUS OXIDE Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit INSIDE UTILITY ROOM Map: Grid: CAS # 10024-97-2 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 250.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 250.00 FT3 Daily Average 250.00 FT3 %Wt. RS CAS # 100.00 Nitrous Oxide No 10024972 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi HAZARD ASSESSMENTS -2- 12/04/2000 '" ;. ..¡ It e f G ROBERT OSBORN DDS INC p= Inventory Item 0003 = COMMON NAME / CHEMICAL NAME WASTE FIXER SiteID: 015-021-002133 ì Facility Unit: Fixed Containers at Site 1 Days On Site 365 Location within this Facility Unit INSIDE XRAY ROOM Map: Grid: CAS # STATE - TYPE Liquid Waste PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 5.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 5.00 GAL Daily Average 5.00 GAL %wt. I Silver HAZARDOUS COMPONENTS ~~ _CAS#74402241 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min HAZARD ASSESSMENTS -3- 12/04/2000 ~~" ~-, e e CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATEIDALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. 5. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I. below for initial submission. . . , : . '. .. It A' . J' , . -I I.- ~. SECTION I: BUSINESS IDENTIFICATION DATA . . I ~.. . . . .. '" . ~ It . ~.'.' .,... ¿ -. . -"J" ,_.. BUSINESS NAME: G . ~ö'cQ'-\-o~bö('f'. '1)~\\CS"· " LOCATION: 4d\oÖ \y-u.'1-\.uV"\ t\\I~. Su~~ ~ \'50 MAILING ADDRESS: 4dloO \r\.J.~~\JL ~u'\k ~ \'50 CITY: ~~~ç\t~.. STATE: (?'. - .zIP.:q~'þH;oN(Io¿'l)~~~~ PRIMARY ACTIVITY: OrQ \ Su~.o..,,"ú\ DeC ~~ . ,.' ,'. ;~\ . . . I,,' , . ¡,." - , . ,-. ,.. . , OWNER: CÎ.:Ro~(2.,~ ~'ooaV\ PHONE[~qß8~ MAILING ADDRESS:4d.1oO -r;.u.1t-ktn -1\\1,( .~u.'\\.<...~'50 rn.'Ó~ç\l\cl.íJl(l35ð1 ..I... .. , . EMERGENCY NOTIFICATION .,' .! ~ ~"k _ D ,_ , ~ " " , . , ~. ,: / . , . .' ,I t CONTACT TITLE BUS. PHONE ~, :.24 HR. PHONE ,1. '('1~~6N(\~, ,Ûb'tvJQ.f1 [)Wrv2r ~dd...q~~ð ~AYÆ. 2. \. )uc:\u c::::...". r'l.Q, ~A ~tdf~r .~'A'öß5· ~ 5Prm¡; \~ 1 e rþr' . .--'" e HAZARDOUSMATEIDALSMANAGEMENTPLAN SECTION 11.1: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: f", XoL: \";) ~c:5....~,,,-<d '" 0. ~\o.c;-\-;L 15 l)o.\ ~\4\~ \..Uh:~ ~~c:. SUO"dat"~ ~~\r'\""'<,,* ......~.. it. UJ\r...t." '5Cjo..\ COY\-\O.\~V- \s "--.\\ ~ COI'\\o...L,,"" ~'" wo...,",,,, ~ 1f'-t""OUA- ^ i.1 . ..-..c> O\~~. Dl. N1.D ~t.""cr' S\..p~"", B. EMPLOYEE AND AGENCY NOTIFICATION: C.bn~LT ~ud~ S~(~~ c«. ~,~(U\ , ~ ~\h~j .:l~ ~( a.v\~W,Q."':J S2t'~ ~ (tDlo\) ~~-C\ßß~ ~, . t V ~". 4 ¿, ~ { .~ c, :'1 ;',. 'It ;, :i "" 1! "~ ¡, l I ' C. " , ...., ENVIRO~NTAL RESPONSE'MANAGEMÊNT: ,.~ud~ ~~(~a.. \.1.)\·X\. ~'/..J.... c.a.( L oC C.~\l\n~ ~f\~ .' Q.""':\""'tw \ \1..\ C) . ,. " ~ ð=.'oo2N\ W\\\ Y'N:>..'t.L.. Su..~~ Q.\\ \~ ~~ QC4r.e., oÇ. ~.' J t. .. I';' .. , . .j :,- . . 'II ~ .. ., , 'f '~.r" D. EMERGENCY MEDICAL PLAN: \..U.t. Y\o.u...L €.O~Uo.-\'\Ot"'\ \)\Q.o \~ f\£<lð~ f'N.~~V'\j ?\o.(.<~ , pll(')On ~ ('~~Ù ðo· . ~. . :\.,0.0.:.. \r\O'....~,; .0...' '~Ò,(a:.L' \)0(.'\1)(" -\0 <t,.4.ct. ,ç Û~~ a,(.(.\ö4l.J~OCl.ur ; ..~: ~"':'"' ~"1" M41; .'.. ....':;....~ ,.:' ~'¡;; " 2 ~ ~ \ r:;' It e HAZARDOUS MATEIDALS MANAGEMENT PLAN SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: D 7... ,'~ ~\-oteÒ v.> \"''"' ~'t'\ oV"ou..J it -to .ptt"4.d" +20M fQu.~ c(/(('" í.rNd on o"'c\ ~ .Q.~ d~. . J Nt.D ,~~tc".,cl w,~ QhA.~ Ot'C'4~ a,,:" -tð-P(.(\1.t.d-1f.o." çA-'\''''~ O&).ft" TU~f,1 on 1- C5H ~~ dq.",\ ~rø.¡A ~"'^ ,'u.~CI.C:\ ~ ~ Q.C\,,\ ~,..d ~t.~Ø'I\ ÒU,,;\<\ . O'~Q",hO ~. . J '¡::nc.l' k (!o~"'dI in 5 ~\ ~on\aW\U Q~ ~~t'1 ~()(\-\Q,I'\«( ~ ~~ ~ ~\~ ~U) B. RELEASE CONTAINMENT AND/OR MITIGATION: , , ..( _.... t .: ,... #'. ~ .... it ~IX.e( no.sSC?cordC\Y'~ e o,,-\.~\V,,~~ ,. ... 'f>< Þf. \ I ..t , . . '.' ~.. ~.. 4J : .... ...~' 1 " ' . , C. ....t CLEAN-UP AND RECOVERY PROCEDURþ:S: . ' ~\\ ~p\Oy-c-<. W~\\ t".cCc.r ~ ~ ~S ~ N\(4Y'\\A.CL\ ú~ Co\\t;)u) Q~1"ßf..'·~k ~c.eJ¿. . .:s; IV\ W 0., rl.n ~¥'N)u.L"S> ç " .,...r ~~~ Þ6 '('\Lw~d UTILITY SHUT -OFFS (LOCATION OF SHUT-OFFS AT YOUR F ACILITIì , , '( ¡, . NATURAL GAS/PROP~: Ea.~~ S;ðe (')C ?uM:,....j NI"} +0 ~\(;.¡.. \'\ððr" ELECTRICAL: fa5\-~lrtL rc hu.ùt\\.....~ f~\li:tn(G \ í2MY\"\ WATER: F Q<y\. <Sì c\~ oÇ nu\\ð.~",~ SPECIAL: LOCK BOX; . Y:ES~ IF YES"LQÇ.ATI01'j:. 0." ' ! . PRIVATE FIRE PROTECTIONIW A TER AVAILABILITY A. PRIVATE FIRE PROTECTION: ~9Î\(\~\tl....s -\-\--rcu.~"'c>\.Ù- öçç; LI!...- Ç',\".(. £Jtl:'~""\5~ Q\cL,.W' ~~ B. WATER AVAILABILITY (FIRE HYDRANT): ~es: In ç,on\- oÇ ÖÇÇ·Ic..JL" 3 e ".~ ¡ ~ -- HAZARDOUSMATEIDALS MANAGEMENT PLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: I £.YV'~\c~-€<~ . ..y... ~ ~:riiÛA~'SAFÉTY"DAT~ SHEETS ON'PILE:' " ~.~~ ~~DS s'h:;~ 'a(~'C\~\\~bk. " t ~...~ ¡ \ ' I ,,', '"'' . . . ~ '" . . yO' . " ,~ .. t }", .' '.. ~ , ';.._ 'j- . . . .It . )3ÎUEF. SUMMARY. OF T,RAINI,NGJ~ROGRAM; ,,~?...\'1 ~c.:,,!~ ,.~~ p!D~\ó.~d (O( 0\\ , , '" ' . ." ' " '~()\04e~'!o, ~ " . .... - ,,'., ~ " # >', , rJ.. 1. - ~.. ...." .'. + _.,. ¡ ~ I ' ',' ".... ~ /. .'; o!: . ~ , It...; ; .: , , ,J".£ -:. Î!" ~Jl t::&k.f' 'f'C6\r'\;~:tn : .. , \. :!:1\~ut'-\ ~ :I:\\~~!> i<'~\)4""'Cr\' ,,". 7.. \\~ 'to-yo(:\ ~o""~U.~\(a.:k'Íons 3. t.~~ ~~ 4. L~.e.r~.o."'~ ~c,.~(\? \o.~s . ":' ~~...,t': . ¡..; ,,\ '" 11' . ~.... . .' .. ~ t: .. , I. .. '!' ,~~ .' .... , '.. I'" . '\ ... '", . ~ ,f , " -'.. . ." t ..- 'f' .! .1 CERTIFICATION I, _ \\ ~l.\ Sþ\ rï..~ CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. ~~\ OS~A CO,.cJ..~ TITLE lli10J DATE 4 r I G. ROBERT OSBORN, D.D.S: .;Nc.- . 0 R A LAN 15 M A X"I L L 0 F A C I A L SUR G E R Y . ANGELINA ALVARADO 4260 Truxtun Ave., Suite 150 Bakersfield, CA 93309 (661) 322-9885 FacSimile (661) 322-7736 ;" e '7~ 10( \O2:-~ \G, " 1 ?-133 CITY OF BAKERSFIELD FIRE ~p ENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3"' Floor, Bakersfield, CA 93301 ~ Ç14 FACILITYNAME Got t20~r OS~I\I nos INSPECTION DATE lð/~,/'Ux/cJ ADDRESS A-~ -rrt~l~ïV',J sffl- ,5:0 PHONE NO. 3"2-"--crg~' FACILITY CONTACT JVi)V SP'/fl-Ki\- BUSINESS ID NO. 15-210- I\.J'r&.J INSPECTION TIME NUMBER OF EMPLOYEES ? Section 1: Business Plan and Inventory Program o Routine ~ombined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Appropriate pennit on hand f?LC~G ~(£-rt£- EJ: R£.(tIæN Business plan contact infonnation accurate WMc-J Rec'ð ,¡,.J ~~t- Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled ?(~e LA&eL..- GA~ ~ Ð~ Housekeeping Fire Protection Site Diagram Adequate & On Hand fL~ P{?e)VlOG £J / APPuCA'17~ C=Compliance V=Violation Any hazardo,\ls waste on site?: . ~es 0 No Explain: L,;J l4--<) íG ç: /?\.C~ Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: WM/GS' 'C;. .... A.J . ¿-<~,-l CJj / 1 ?133 CITY OF BAKERSFIELD FIRE D~P NT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3"' Floor, Bakersfield, CA 93301 ç Çf4 FACILITYNAME G., (2.oß6n'í aS~A! noS INSPECTIONDATE IcJ/~J/~d ADDRESS -4-%0 -¡r¿v¡{ìVrJ <;.'f'é- pÇf) PHONE NO. 3"2..'L-'1'g~' FACILITY CONTACT ,JU1)¥ SPC/Jt.Kh- BUSINESS ID NO. 15-210- f\J'e...) INSPECTION TIME NUMBER OF EMPLOYEES 7 ,02-~C \C Section 1: Business Plan and Inventory Program o Routine lØ£ombined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Appropriate pennit on hand PLC~G C.01No.Pu:-rr: ~ «:"Ervæ.JJ Business plan contact infonnation accurate WNC-J R.~c,,) ,,..; 1"ü-tG" VI.A.4. b- Visible address '" '. Correct occupancy Verification of inventory materials , Verification of quantities Verification of location Proper segregation of material , Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled ?(,~e (~'- G-A~ ~ I()~ Housekeeping Fire Protection Site Diagram Adequate & On Hand fL~ !?(?olll,* t.J/ APPUCh17N C=Compliance V=Violation Any hazardo);l~ waste on site?: fSiyes 0 No Explain: Lr' bQ-<; rG F ....~ C~ White - Env. Svcs, Yellow - Station Copy Pink - Business Copy Ot, ^~\ ~(\ .~ ~\\C1 . , Busin s Site esponsible Party Inspector: W t~ S' Questions regarding this inspection? Please call us at (661) 326-3979 -FACILITY NAME G~ ~c>ß~, C)~6ot2lJ DOS INSPECTION DATE lð/~, /'2&t;.t) Section 4: Hazardous Waste Generator Program EP A ID # o Routine ß-Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EP A ID Number (Phone: 916-324-1781 to obtain EP A ID #) Authorized for waste treatment and/or storage Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondary containment provided V Ç'LC-A-,,> 6 ç'(4}\Ic 0E I,lt<~V 1/ Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels Proper management of used oil filters Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal C=Compliance V=Violation Inspector: /{ ~( ~5 Office of Environmental Services (661) 326-3979 White - Env, Svcs. ~<ð~·~t~G . usin Site esp nsible Party Pink - Business Copy . CITY OF BAKERSFIELJA OFJfCE OF ENVIRONMENTAL SrkVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one tonn per mal8rfsl per buDding or area) Page of CHEMICAL LOCATION 3 FACILITY 1011 CHEMICAL NAME ð-JzY6-C~ COMMON NAME CAS # 207 ES (Complete if requested by local fire chief) 209 FIRE CODE HAZARD TYPE PHYSICAL STATE o s SOUD FED HAZARD CATEGORIES (Check aU that apply) ANNUAL WASTE AMOUNT o 1 FIRE UNITS" STORAGE CONTAINER (Check an that apply) o a ABOVEGROUND TANK o Þ UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEa DRUM STORAGE PRESSURE o a AMBIENT STORAGE TEMPERATURE ~IENT 226 2 230 3 234 4 238 5 242 RE o m MIXTURE 211 RADIOACTIVE DYes 0 No o Yes 0 No 202 204 o Yes 0 No 206 If Subject to EPeRA. refer to instructions DYes 0 No I 210 i ¡ 212 CURIES 213 , i 215 [ I o w WASTE o I LIQUID J84-GAS 214 lARGEST CONTAINER 2-S( 219 STATE WASTE CODE í 218 ¡ 220 frREACTIVE ~SSURE RELEASE 04 ACUTE HEALTH o 5 CHRONIC HEALTH 221 DAYS ON SITE 222 217 MAXlt.tJM ..--;;; DAILY AMOUNT ,,:) 0 "1.- o ga GAL ~CUFT . If EHS. amount must be In 1Þs. 218 AVERAGE DAILY AMOUNT o Þ LBS 0 In TONS o q RAIL CAR o r OTHER 223 De PLASTlCINONMETALUC DRUM Of CAN o 9 CARBOY o h SILO o I FIBER DRUM OJ BAG Ok BOX ~NDER o m GlASS BOTTLE o n PLASTIC BOTTLE DO TOTE BIN o p TANK WAGON 224 o 88 ABOVE AMBIENT o Þa BELOW AMBIENT o c CRYOGENIC 225 m Dyes ONo 228 231 o Yes 0 No 232 235 D Yes 0 No 238 239 D Yes D No 240 243 Dyes 0 No 244 UPCF (7/99) 6- ABOVE AMBIENT D Þa BELOW AMBIENT 229 233 237 241 245 S:\CUPAFORMS\OES2731.TV4.wpd I CITY OF BAKERSFIELa OF CE OF ENVIRONMENTAL S~VICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION BUSINESS NAME (58me as ITY NAME 01 DBA . Doing Business As) <:3., ~ 2Yj~ CHEMICAL LOCATION FACILITY ID 1# CHEMICAL NAME ~TRðcJ".:> COMMON NAME CAS 1# o Yes 0 No 202 204 DXcIJ1? o Yes 0 No 206 If Subject to EPCRA. refer to instructions 207 SSES (Compfete if requested by local flre chieI) 209 FIRE CODE HAZARD TYPE PURE PHYSiCAl STATE o s saUD FED HAZARD CATEGORIES (Check all that apply) ANNUAl WASTE AMOUNT 01 FIRE UNITS' STORAGE CONTAINER (Check all that apply) o a ABOVEGROUND TANK o b UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEel DRUM STORAGE PRESSURE o a AMBIENT STORAGE TEMPERATURE p..e.eIENT 226 2 230 3 234 4 238 5 242 o m MIXTURE o w WASTE RADIOACTIVE DYes oNo DYes oNo 208 210 212 CURIES 213 , ! 211 o I LIQUID ~S 214 215 ! i 216 219 STATE WASTE CODE 220 LARGEST CONTAINER zço 221 DAYS ON SITE 222 o 2 REACTIVE ~SSURE RElEASE o 5 CHRONIC HEALTH o q RAIL CAR o r OTHER 223 04 ACU'TEHEALTH 217 MAXlMJM DAILY AMOUNT '2.- 'S"'V o ga GAL ~CUFT . If EHS. amount must be in lbe. 218 AVERAGE DAILY AMOUNT o Ib LBS 0 In TONS 224 o as ABOVE AMBIENT o be BELOW AMBIENT o c CRYOGENIC 225 229 233 237 241 245 UPCF (7/99) o e PLASTICINONMETALUC DRUM Of CAN 09 CARBOY o h SILO o i ABER DRUM OJ BAG Ok BOX ~INDER o m GLASS BOTTLE o n PLASTIC BOTTLE 00 TOTE BIN o p TANK WAGON ~ ABOVEAMBIENT o be BELOW AMBIENT -227 o Yes 0 No 228 231 o Yes 0 No 232 235 o Yes 0 No 236 239 o Yes 0 No 240 243 o Yes 0 No 244 S:\CUPAFORMS\OES2731.TV4.wpd CHEMICAL NAME L.J'A;ss ye COMMON NAME CAS' . CITY OF BAKERSFIEL. OFJ'lCE OF ENVIRONMENTAL STRVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION ~, :x-.c--R-.. 201 FIRE CODE HAZARD CLA ES (Complete if requested by local lire 209 TYPE opPURE PHYSICAL STATE o s SOUD FED HAZARD CATEGORIES 0 1 FIRE (Check all that apply) ANNUAL WASTE _ ~" AMOUNT ¿.(/ UNITS' STORAGE CONTAINER (Check aU that apply) o a ABOVEGROUND TANK Db UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEB. DRUM o m MlXT\JRE 211 RADIOACTIVE DYes oNo (one form per material per building or a_) Page ot DYes 0 No 202 204 o Yes 0 No 206 If Subject to EPCRA. refer to instructions 210 i 212 CURIES _,213 , i WASTE ~ID 214 LARGEST CONTAINER s- 215 [ ! 216 219 STATE WASTE CODE 220 ogGAS o 2 REACTIVE o 4 ACUTE HEAlTH o 5 CHRONIC HEAlTH 221 DAYS ON SITE 222 o 3 PRESSURE RElEASE o q RAIL CAR o r OTHER 223 211 MAXlYJM DAILY AMOUNT s- 218 AVERAGE CAlLY AMOUNT STORAGE PRESSURE ~ AMBIENT o sa ABOVE AMBIENT o ba BELOW AMBIENT 224 STORAGE TEMPERATURE ~MBIENT o sa ABOVE AMBIENT o be BELOW AMBIENT o c CRYOGENIC 225 226 221 Dyes oNo 228 229 2 230 231 o Yes 0 No 232 _ 233 3 234 235 o Yes 0 No 236 231 4 238 239 DYes 0 No 240 241 5 242 243 o Yes 0 No 244 245 ogaGAl odCUFT . If EHS. amounl mUSl be in Ibs, o Ib LBS o In TONS UPCF (7/99) o e PlASTlCINONMETAWC DRUM, Of CAN o 9 CARBOY o h SILO o FIBER DRUM OJ BAG Ok BOX o I CYLINDER o m GLASS BOTTLE ~TlCBOTTLE 00 TOTE BIN op TANK WAGON S:\CUPAFORMS\OES2731.TV4.wpd