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Home My WebLink AboutBUSINESS PLAN 5/15/2008TRUXTUN SURGERY CENTER 4260 TRUXTUN AVE., SUITE 120 i Per PERMIT ill # 015-021-002132 l\'," ¡"""'i:C:::n::':~~,;ti;:,- TRUXTUN SURGERY cErfi7£'e':'~";:l~~~ ~{,f:,:!::',¡, l!~~?):"'·' 1{i'" ¡:rj:;!;\~. LOCATION: 4260 TRUXTUN AvE' . " ,0' , ij' \\ rll.~f/ \ ~ ~ .~ f i " . ~ þ..~ :' .). ,(' t ~, \ ,\ ~~. \1. U ,_' 1 \l t,\ \~, t'f h~~ ¡:-': \\\~;..';Lti;. // '/i: '~::,C~C!"~~'~-"~, -'-"'}À /;S~" /::\~. '!{-'.'- . " "~':/\'t,.. . ' Q\:..,"V" \\ . '--:"--,~ i'. . J~~.~_~ciiJ~~~í~~~_ .\-<"~~ ¿/.( ',' . ';~' (r-'~" '-:::.'::,-":~/" ii/;"; ¡! - - Issued by: it Operil.te to Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This oermlt Is Issued for tine following: It! Hazardous Materials Plan o Underground Storage of HaZSlrdous Materials o Risk Management Program o Hazardous Waste On-Site 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: AUG June 30, 2003 Per It to Operil.te e , " . LOCATION , e Issued by: Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF ,PERMrr:,:ON REVERSE SIDE , . ". .' : . This oermlt Is Issued for the following: Ii1 Hazardous Materials Plan [] Underground Storage of Hazardous Materials , 0 Risk Management Program [] Hazardous Waste On-Site Treatment 4260 CA 93309 Bakersfiela Fire Department OFFICE OF ENVIRONMENTAL SER VICES' 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX ,(661) 326-0576 JAN 2 4 200t .. Approved by: . :' ~. ''''.'~' Issue Date ;:-':J. '." .~ , .' .' '> II:" .'; : . ..,¡', . ',-.' . .~ ';::ExP#'åt~ónpate: '. .: ::~":.," ':7 ; ~ " -, . '::'.:. '. . 'June 30, 2003 'I'RUXTUN SURGERY CEN'fEJ, INC. 4260 TRUXTUN AVENUE, SUITE 120 BAKERSFIELD, CA 93309 ~.s;-(e. ì)ìo..~ftLM . "@O{~ J .~. 6o{t. _... '* Sprr6,,&(..I(lf !oc..a.t~s: ,. s.~(.)~ þJ,vvt..t--- (,-tFi oxy r { (0"1¡(,He-i C)~ ~; .t I íf., hi &-/~ ¡...-~ 1" rflJ!- - sa. Skuk kr vhL~ sh",y-a (.~~ , , ~ ~~\, ~ -î c: Qro;l Q[g! ~ mtJ' ¥ -if- ~ EQ/STRETCH êJ [illj ~ SUPVR !ill] CORRJD--DR @I1 ? * ENDO ~ ENDO [ill] ¡t , J I I;: I : ~ rcb SOIL rm [@'T J I , ¡i'~ \ *0 FEMALE IX· @] I L____ ~ BREAK üillW' -l -~ N 41 b~\,: ~ tvV).-ú.., IfU'/.. M I\V£.- FLOOR PLAN 024 1_ 8 - 15 I ~~ - .: t~ TRUXTUN SURGERY CENTER INC SiteID: 015-021-002132 Manager MARY MOEDER Location: 4260 TRUXTUN AVE 120 City BAKERSFIELD BusPhone: (661) 327-3636 Map 102 CommHaz Moderate Grid: 25C FacUnits: 1 AOV: CommCode: BFD STA O1 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title MARY MOEDER / ADMINISTRATOR ROSE MATA / SENIOR TECH Business Phone: (661) 327-3636x Business Phone: (661) 327-3636x 24-Hour Phone (661) 832-8923x 24-Hour Phone (661) 837-8649x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact MARY MOEDER Phone: (661) 327-3636x MailAddr: 4260 TRUXTUN AVE 120 State: CA City BAKERSFIELD Zip 93309 Owner TRUXTUN SURGERY CENTER INC Phone: (661) 327-3636x Address 4260 TRUXTUN AVE 120 State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT q~ ~ !~i r ~`i ~~~ (;°a~c~d on my inquiry of those individuals ta;r?ing the inferma~ion, I certify l: , re.7p:~ns{t,le for o under ~;enalty of law, that ! have personalty i on ir~etf and am familiar with the informat eaam sut~mitteci and i~~lieve the information is true, accurate, and compiete• / ~E~' `~ ,Z ~!~ Date gnature -1- 07/16/2007 ~_ F TRUXTUN SURGERY CENTER INC SiteID: 015-021-002132 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... ISpecHazIEPA Hazards) Frm I DailyMax IUnitIMCPI OXYGEN COMPRESSED AIR DIESEL, EMERG. GEN. FUEL F IH DH G G L 753.00 FT3 Low 750.00 FT3 Min 55.00 GAL UnR -2- 07/16/2007 ~, -3- 07/16/2007 s F TRUXTUN SURGERY CENTER INC SiteID: 015-021-002132 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME/ CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: MEDICAL GAS ROOM CAS# 7782-44-7 STATE T TYPE T PRESSURE ~~ TEMPERATURE ~~ CONTAINER TYPE ~ ~GaS I Pure I Above Ambient I Ambient I PORT. PRESS. CYLINDER I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 251.00 FT3 753.00 FT3 251.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 nt~c~titcL r-~~a~~ai~i~ivl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME COMPRESSED AIR Days On Site 365 Location within this Facility Unit Map: Grid: MEDICAL GAS ROOM CAS# ~GasATE ~Mixtur~ Ambient~E ~ AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Co248100rFT3 Daily M50100m FT3 I Daily 248r00e FT3 r]-C1L~ti[CJJV I/w7 l.Vl"lt'V1V L,1V 1.7 %Wt. RS CAS# 100.00 Air No 0 ruyc~ru~u r~a a~aai~tnivta _ _ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Min -4- 07/16/2007 ~ f F TRUXTUN SURGERY CENTER INC SiteID: 015-021-002132 ~ ~ Inventory Item 0003 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 TMixture I Ambient ~ Ambient OTHER - SPECIFY AMOUNTS AT THIS LOCATION Largest Con55~00rGAL Daily M55100m GAL I Daily A55r00e GAL ~Wt. RSA CAS# t1E~Y,H.ttL H~~~~al~lL'1V15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UnR HAZARDOUS COMPONENTS -5- 07/16/2007 f F TRUXTUN SURGERY CENTER INC SiteID: 015-021-002132 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification .01/24/2001 ~ IF LEAK IS DETECTED WE WILL CHANGE TANK IMMEDIATELY. CONTRACT WITH AIR LIQUIDE TO CHECK TANKS WEEKLY. Employee Notif./Evacuation 03/27/2006 STAFF TRAINED FOR EMERGENCIES. STAFF WILL BE NOTIFIED OVERHEAD FOR ANY EMERGENCY. ADMINISTRATOR WILL CALL APPROPRIATE AGENCIES 911, 800-852-7550, 326-3979. ALSO EMERGENCY SHUTOFF SHEET WILL BE UTILIZED. Public Notif./Evacuation 03/27/2006 CENTER IS CONTRACTED WITH STERICYCLE FOR CONTAMINATED WASTE. ALL WASTE CONTAMINATED IS RED BAGGED AND SECURED PER POLICY. Emergency Medical Plan 02/27/2007 SEE ATTACHED PLANS -6- 07/16/2007 .; F TRUXTUN SURGERY CENTER INC SiteID: 015-021-002132 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 01/24/2001 ~ TANKS ARE SECURED TO WALL WITH CHAINED IN LOCKED CLOSET. Release Containment 01/24/2001 CENTER IS CONTRACTED AIR LIQUIDE TO CHANGE TANKS WEEKLY. EMPLOYEES ARE TRAINED TO CHANGE TANKS IF NEEDED. Clean Up 03/27/2006 OXYGEN AND COMPRESSED AIR DOES NOT REQUIRE CLEAN-UP. Vt~11C1 iCC.7VUI l:C HC: l.1Vdl.1 V11 -7- 07/16/2007 .; F TRUXTUN SURGERY CENTER INC SiteID: 015-021-002132 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .'~~JCC:1d1 ild'GdLUS Utility Shut-Offs GAS - BACK EXIT HALLWAY MEDICAL GAS CLOSET ELECTRIC - ELECT CLOSET IN A&D RM WATER - E SIDE OF BLDG OUTSIDE 02/27/2007 Fire Protec./Avail. Water 11/22/2006 PRIVATE FIRE PROTECTION - 2 FIRE ALARMS, SPRINKLER SYSTEM, SMOKE BARRIER WALL, AND 3 FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - 50FT AWAY AND 60FT AWAY. Building Occupancy Level 02/27/2007 23 EMPLOYEES -8- 07/16/2007 ~ r 7~ F TRUXTUN SURGERY CENTER INC SiteID: 015-021-002132 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 02/27/2007 ~ MSDS SHEETS IN SCOPE ROOM AND IN OFFICE. BRIEF SUMMARY OF TRAINING PROGRAM: OSHA TRAINING WITH INJURY AND ILLNESS PREVENTION AND HAZARD COMMUNICATIONS YEARLY. 4 FIRE DRILLS EVERY YEAR. FIRE SAFETY AND SMOKE BARRIER WALL TRAINING YEARLY. CONTRACTED WITH JORGENSEN TO TRAIN STAFF USING FIRE EXTINGUISHER YEARLY. DISASTER DRILL FOUR TIMES A YEAR. EMERGENCY SHUTOFF INSERVICE YEARLY. HAZCOM MSDS TRAINING YEARLY. STERICYCLE MEDICAL WASTE INSERVICED STAFF. ruyC ~ Held for Future Use nC1u tVi rul.uLC USC -9- 07/16/2007 ~~, -, +--_ TRUXTUN SURGERY CENTER INC Manager 1`~~if~.~1 -'Y1 t1~e d Ei' Location: 4260 TRUXTUN AVE 120 City BAKERSFIELD CommCode: BFD STA Ol EPA Numb: BusPhone: Map 102 Grid: 25C SIC Code: DunnBrad: SiteID: 015-021-002132 (661) 327-3636 CommHaz Moderate FacUnits: 1 AOV: Emergency Contact / Title Emergency Contact / Title MARY MOEDER / ADMINISTRATOR ROSE MATA / SENIOR TECH Business Phone: (661) 327-3636x Business Phone: (661) 327-3636x 24-Hour Phone (661) 832-8923x 24-Hour Phone (661) 837-8649x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact (~T,Y'~j i'Y~l~ede(L~ Phone: (661) 327-3636x MailAddr: 4260 TRUXTUN AVE 120 State: CA City BAKERSFIELD Zip 93309 Owner TRUXTUN SURGERY CENTER INC Phone: (661) 327-3636x Address 4260 TRUXTUN AVE 120 State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT E~r~ ~~~ z s z0®~ used on my inquiry of those indivit.taa~s responsible for obtaining the information, I certif;~ under penalty of la~i that I have personalty examined and am familiar with the information submitted and believe the information is tru e, accurate, and complete. ~ ~~ Sig ature ' - ~ J pa -1- 02/20/2007 W,~ ~L F TRUXTUN SURGERY CENTER INC ~ Hazmat Inventory ~ MCP+DailyMax Order = SiteID: 015-021-002132 ~ By Facility Unit ~ Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F IH DH G 753.00 FT3 Low COMPRESSED AIR G 750.00 FT3 Min DIESEL, EMERG. GEN..FUEL L 55.00 GAL UnR -2- 02/20/2007 y1 ~j' -3- 02/20/2007 -,y -~ ,~ F TRUXTUN SURGERY CENTER INC SiteID: 015-021-002132 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: MEDICAL GAS ROOM CAS# 7782-44-7 ~GaSATE TYPE T PRESSURE ---~- TEMPERATURE --~ CONTAINER TYPE TPure I Above Ambient I Ambient I PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 251.00 FT3 753.00 FT3 251.00 FT3 HAZARDOUS COMPONENTS °sWt. RS CAS# 100.00 Oxygen, Compressed No 7782447 t1HGL~ICL L-~J Jt',J~1~1tS1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME COMPRESSED AIR Days On Site 365 Location within this Facility Unit Map: Grid: MEDICAL GAS ROOM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TMixture T Ambient ~ Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 248.00 FT3 750.00 FT3 248.00 FT3 HAZARDOUS COMPONENTS oWt. RS CAS# 100.00 Air No 0 ril'iL+HKL .[~J~JL" .7J1~1L" 1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies. / / / Min -4- 02/20/2007 ~ . l F TRUXTUN SURGERY CENTER INC = ~ Inventory Item 0003 SiteID: 015-021-002132 ~ ~ Facility Unit: Fixed Containers at Site ~ 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 oWt.~ RS CAS# tif~GKKL A5J1'~~~l~lt'~1V 1'S TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UnR -«~ -5- 02/20/2007 F TRUXTUN SURGERY CENTER INC SiteID: 015-021-002132 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 01/24/2001 ~ IF LEAK IS DETECTED WE WILL CHANGE TANK IMMEDIATELY. CONTRACT WITH AIR LI4UIDE TO CHECK TANKS WEEKLY. Employee Notif./Evacuation 03/27/2006 STAFF TRAINED FOR EMERGENCIES. STAFF WILL BE NOTIFIED OVERHEAD FOR ANY EMERGENCY. ADMINISTRATOR WILL CALL APPROPRIATE AGENCIES 911, 800-852-7550, 326-3979. ALSO EMERGENCY SHUTOFF SHEET WILL BE UTILIZED. Public Notif./Evacuation 03/27/2006 CENTER IS CONTRACTED WITH STERICYCLE FOR CONTAMINATED WASTE. ALL WASTE CONTAMINATED IS RED BAGGED AND SECURED PER POLICY. PrlLlClyClll~~/ 1"1C U1C:d1 t'l dll Se,Q. ~, ~~~~ ~> Pt ~-~ S -6- 02/20/2007 F TRUXTUN SURGERY CENTER INC SiteID: 015-021-002132 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 01/24/2001 ~ TANKS ARE SECURED TO WALL WITH CHAINED IN LOCKED CLOSET. Release Containment 01/24/2001 CENTER IS CONTRACTED AIR LIQUIDE TO CHANGE TANKS WEEKLY. EMPLOYEES ARE TRAINED TO CHANGE TANKS IF NEEDED. Clean Up OXYGEN AND COMPRESSED AIR DOES NOT REQUIRE CLEAN-UP. 03/27/2006 v~.iici iccav ul_l~C tic.: l.lVdl..1 V11 ,-7- 02/20/2007 F TRUXTUN SURGERY CENTER INC SiteID: 015-021-002132 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ a~c~iai na~aiu~ U1.11yy1~~~~1~~y .7ilUl.-VLLS w~~f~~c~~ Em~~'~~y~~~~v~-~s Fire Protec./Avail. Water 11/22/2006 PRIVATE FIRE PROTECTION - 2 FIRE ALARMS, SPRINKLER SYSTEM, SMOKE BARRIER WALL, AND 3 FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - 50FT AWAY AND 60FT AWAY. Building Occupancy Level 23 ~ EMPLOYEES 02/28/2006 -8- 02/20/2007 rd ~ ~. ~ }.. F TRUXTUN SURGERY CENTER INC SiteID: 015-021-002132 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 11/22/2006 ~ MSDS SHEETS IN SCOPE ROOM AND IN OFFICE. BRIEF SUMMARY OF TRAINING PROGRAM: OSHA TRAINING WITH INJURY AND ILLNESS PREVENTION AND HAZARD COMMUNICATIONS YEARLY. 4 FIRE DRILLS EVERY YEAR. FIRE SAFETY AND SMOKE BARRIER WALL TRAINING YEARLY. CONTRACTED WITH JORGENSEN TO TRAIN STAFF USING FIRE EXTINGUISHER YEARLY. DISASTER DRILL .~7c~C EMERGENCY SHUTOFF INSERVICE YEARLY. HAZCOM MSDS TRAINING YEARLY. STERICYCLE~E MEDICAL WASTE INSERVICED STAFF. ` rage ~ , Held for Future Use nc.iu iii r u~.uic vac -9- 02/20/2007 UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1: Business Plan and Inventory Program • ~." Prevention Services A F x s ~, 0 900 Truxtun Ave., Suite 210 FARE Bakersfield, CA 93301 aRrM _ --Tel.: (661).326-3979 Fax: (661) $72-2171. FACILITY NAME ,/ -_ ~ ~ ~ ~ S ~~ INSPECTION ~ TE `G INSPE~T~ION TIM~~ ~-- r u /L- !~ ~ V ) ADDRESS - ~- ~y'c,- o~t~,~-~.. PHONE NO. 3z~ 3~3~ O OF EMPLOYE ~S~ FACILITY CO ACTS. _ , t~ BUSINESS ID NUMBER 15-021- ~G~'j ~~' l r ___~' ~ r- _ - -- _-~___- - _ __ _ - --~~ C Section 1: Business Plan and Inventory Program ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C- V l C=Compliance OpERATiON V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND /' 'AQ ^ BUSIf1eSS PLAN CONTACT INFORMATION ACCURATE / , ^ 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 ~I ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ~ '° 2DO ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTEC710N ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 r r ~ ~' Inspector (Please Print) Fire Prevention / 1" In /Shift of Site/Station # Business Site / Responsib a Party ( e e Print) ^ YES ^ NO White -Prevention Services . Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 ,, ~. + TRUXTUN SURGERY CENTER INC'__________________________ SiteID: 015-021-002132 + Manager Location: 4260 TRUXTUN AVE~120 City BAKERSFIELD BusPhone: (661) 327-3636 Map 102 CommHaz Low Grid: 25C FacUnits: 1 AOV: CommCode: BFD STA O1 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title MARY MOEDER / ADMINISTRATOR ROSE MATA / SENIOR TECH Business Phone: (661) 32'T-3636x Business Phone: (661) 327-3636x 24-Hour Phone (661) 832'-8923x 24-Hour Phone (661) 837-8649x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact Phone: (661) 327-3636x MailAddr: 4260 TRUXTUN AVE~120 State: CA City BAKERSFIELD Zip 93309 Owner TRUXTUN SURGERY CENTER INC Phone: (661) 327-3636x Address 4260 TRUXTUN AVEI120 State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: ~ Emergency Directives: ~ PROG A - HAZMAT ENT ~p R 2 ~ zoos Eiased on my inquiry of those individuals responsible for obtaining 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, accurate, and complete. o~~ Sig atur Date -1- 02/28/2006 `V~y` T~ CITY OF BAKERSFIEI.D FIRE DEPARTMENT b OFFICE OF ENVIRONMENTAL SERVICES ~' , y~ UNIFIED PROGRAM INSPECTION CHECK[.IST ~wE a~„i~ 1715 Chester Ave., 3rd i'loor, Bakersfield, CA 93301 FACILITY NAME ~~ J~ ~~~~ INSPECTION DATE ~~~~3~°3 _ ADDRESS ~-2 IZJ~oTJ~ ~ l~y PHONE NO. 327 -~~ FACILITY CONTACT LIZ ~/~~~-rte BUSINESS ID NO. IS-210- ~~3Z- INSPECTION TIME ZO M~~l NUMBER Of EMPLOYEES 20 Section 1: Business Plan and Inventory Program Routine ^ Combined ^ Joint Agency ^Mu1ti-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location / Proper segregation of material Verification of MSDS availability Verification of Naz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: ^ Yes No Q~~ ~~ Explain: ti. Questions regarding this inspection? Please call us at (661) 326-3979 Busines ite Responsible Party Whitr -Env. Svcs. Yellow • Station C ~ ~a " ~ opy Pink -Business Copy Inspector: l~ " - e ;.~. TRUXTBN SURGERY CENTER INC SiteID: 015-021-002132 Manager Location: 4260 TRUXTUN AVE 12~ City BAKERSFIELD BusPhone: Map : 102 Grid: 25C (661) 327-3636 CommHaz : Minimal FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 01 EPANumb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title MARY MOEDER / ADMN / Business Phone: (661) 327-3636x Business Phone: ( ) - x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact : Phone: (661) 327-3636x MailAddr: 4260 TRUXTUN AVE 120 State: CA City : BAKERSFIELD Zip : 93309 Owner TRUXTUN SURGERY CENTER IN~'\fEt)) Phone: (661) 327-3636x Address : 4260 TRUXTUN AVE 120 RECE\ State: CA City : BAKERSFIELD ~ ~ ?~~ Zip : 93309 Period : to IJ ).\'t ... - TotalASTs: = Gal Preparer: c;:.f:~\J'C~S TotalUSTs: = Gal Certif'd: E~,,\~f\~~ . " RSs: No Emergency Directives: One Unified List ì All Materials at Site ì F Hazmat Inventory p== As Designated Order Hazmat Common Name... SpecHaz EPA Hazards DailyMax MCP COMPRESSED AIR OXYGEN F IH DH G G 750.00 FT3 Min 753.00 FT3 Low I, (Type or print name) Do hereby certify that ! have reviewed the attached hazardous materials manage- ment plan for (Name of Business) andïhaï it along with any corrections constitute a complete and correct man- agement plan 10r my facility. -1- 12/04/2000 SignalUre Date ": - '1: . e F T8pxT&~ SURGERY CENTER INC f= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME COMPRESSED AIR SiteID: 015-021-002132 ì Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit INSIDE MEDICAL GAS ROOM Map: Grid: CAS # TYPE Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 248.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 750.00FT3 Daily Average 248.00 FT3 HAZARDOUS COMPONENTS ~ CAS # 01 I %Wt. I 100.00 Air TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Min HAZARD ASSESSMENTS f= Inventory Item 0002 = COMMON NAME / CHEMICAL NAME OXYGEN Facility Unit: Fixed Containers at Site ì Days On Site 365 Location within this Facility Unit INSIDE MEDICAL GAS 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 753.00 FT3 Daily Average 251.00 FT3 %Wt. RS CAS # 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS TSecret RS B:j.oHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low HAZARD ASSESSMENTS -2- 12/04/2000 .. ' ~' , ~--- f N ! e _ SITE DIAGRAM ~ClLlTYDIAGRAM l -----I Business Name: . Business Address: - _ ' ~ &~J0 """-, 'T 3:3 <J¡C oF . ' ¡' l' 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 fonn 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 / Op~rator Fonn and Chemical Description Fonn(s) to the front of this plan instead of completing. SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA BUSINESS NAME: "ÍVV ¡t{vV\... SVIf"J e.v) te.r>-kv LOCATION: MAILING ADDRESS: y1.C:>O I Vu '1- tV!/) A\Jl-. SUI k I 2.ü CITY: (bv..-'Ú./r;, .fIe. (J STATE: CPr ZIP:C3>:S!2PHONE: PRIMARY ACTIVITY: E ndo SLOp) C~-J<...r. £?vi ldl "') 5pdce. l.tac;.tJ. b1 f-\-;-~ ~~ t¡ MAILING ADDRESS: ~qOú Cv.-(. ¡w."'tC A-Jf.. 3l7-3b 3Co OWNER: PHONE: '323- 33 6u ~)h.eld cA EMERGENCY NOTIFICATION CONTACT 1. tJ\o.:¡ 'J MotdV' 2. i4 f(U)/J M~tCA- TITLE Adf\lt ()~1vdt/ .:tnv l' ecM¡(.¡~ BUS. PHONE 24 HR. PHONE 32.1· ~3(, 3L7'~3fv ~)2-<61l, <is' ~ 7- ~L,tf í 1 -, e " HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II.I: DISCOVERY AND NOTIFICATIONS ~ A. LEAK DETECTION AND MONITORING PROCEDURES: CD \.Ç \lðK.. 1"5 dLkGkcÁ / U,){, l....) \ l \ cJr.~y.- t"2/\[ I ^,,~dL'k~ I ø ~..jy ~v\-" l;-J t ~ PJL r Ll '\ \.¡ a.cLt.. tu cP.t <...K.- ,f2¥\tLJ ~ I @- ,,' B. E!v.1PLOYEE AND AGENCY NOTIFICATION: " , CD S+tÁJ-~ +rZlf\td. ~ e.-~'?f~C-Ll-~, S{i. eAc..iCJ>l ~p I iM-S , ® S~}-r Cr-,¡l ~ l'\ùh~.L O\kíhtt:...~L k..r~J ~~~ì 0. A~l\ltrc...1v- µJ¡l,l (¿ll 2-ffl'0f/'~J.¿ ~)e",qL~ I ( 1 , ~) t - 8«J - ~s 2. . 7 5) U) h~ I' 3 Zc.· 3 71 ) ) G) AI~u, e.~ sI,~~'ù{(¡ ~ ~,vllx _I.t."... . C. ENVIRONMENTAL RESPONSE MANAGEMENT: CD ø (3) CV'I.kr LS CÚ\-fv¿ck.-t .,..."Joh ~F' -fv- ~J2N\II\C/W /,J?)!l ~ AU ¡..Il)~ / cÙl)þ~,r¡,- kL tJ It'& h25<¿f.L t.: ~ü-¡{ec.L fV Fh~ ø S.u.. ~ {.,hGkJ~..t.. fi)¡'~. D. EMERGENCY MEDICAL PLAN: S'(¿ eJ\cl()~L pit/\.. 2 -it . \" ,e e HAZARDOUS MATERIALS MANAGEMENT PLAN " SECTION 11.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: (1) -Ld1!.S (;J-0 St~ ..J.o W.?tt "'" l'~ ch4~ t"\ !o<..j{¡z4 clo.k ~ . @ Sa €.'\c.lu~ ~/)JVJJ~' IIl~ (j fle.v'(/j*-~^ fÆJJ/c""" B. RELEASE CONTAINMENT AND/OR MITIGATION: C~kr l~ ~lJ' c...:>/) y.¿~ [/Y) f L,û ~ os At( LI.' \..t ~ 6L Ie 1v2{1·~..~ +c> cfI £., J ¿ t- ÒI ¡:~ J-u cA e.....(f -I z.,.. ¡( s ,.ç /'Vi.tlJ C. CLEAN-UP AND RECOVERY PROCEDURES: Ot'-i~ & CO/\l\ fM ~~ ()...W dot. ~ ¡I\-...I}- ve1 ¡)~ c.-U ~'^ w/ ( UTILITY SHUT -OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) 9£ Û\(J(.j~ ~-.. NATURAL GAS/PROPANE: ELECTRICAL: WATER: SPECIAL: LOCK BOX: YES/NO IF YES, LOCATION: PRIVATE FIRE PROTECTION/W A TER AVAILABILITY A. PRIVATE FIRE PROTECTION: - Cell,ju- 1I1l.~ Z hl'G, ¿Iu,-; I 0.- 5f{'1~ S'1~AI\ ) ~&,vf~1 ~ '3 -hI'<.. .(~f1^)....o.N.o'>t Ce/'l~ his L.{ hrc:. d.("dl~~lçr~ Ð, fv'Ó!. -tthI\.1\"LS~ c..lJ» "Ij2r~. Sfz-..fJ I,) i.J\.UfI.Jt.u;:{ o'\..h~ (JrI"Ó).t~ 'L.~'-J. B. WATER AVAILABILITY (FIRE FiYDRANT): l,. OV'\e.· SJ..Ç~ ¿ ù¡ (¡/ ()I\l... 00.c+ ¿V?/. 3 _ :el HAZARDOUSMATEIDALSMANAGEMENTPLAN -I'J .-', ~. SECTION III: TRAINING NUMBER OF EMPLOYEES: ~ C> MATERIAL SAFETY DATA SHEETS ON FILE: 'itS j IV) SCQfL (00""'0 ~ 4~ o.ffi~ BRIEF SUMMARY OF TRAINING PROGRAM: f7"\ 0 h 1., .k.. ~'--rllN ':>~ {JfeJ-t'\~ ø{ t\z 2..2..f¡- ¡ . \.!; .s ð--T'ðélll^J (.,..)'0-\ /"j"'{j'~ '4, C':>.rtlN\ W\ .uf\..~ '> 'iW1Ô' (1) 11 hIe. dr, \ S eWj ~:-/. Q) i=i(~ sc;..k.~ ': S~...~62~r~ ~tl \ fvà-/)'l\-c~ YØÁ/'~ ¡ (j) ~CnW2~ "'" h JO/'f'~' +v ~àil\. S- fk..-J..i- USl./t") Fi/<.. e.olhl\~f·~.)~ 'f£.¿/~. ~ D I c;... '> k/ Dr" l ./-t-vL"'- c:... 'fº-::V--- ¡ @ ~ ~~J Shu} ca.> t"t- ~/UI U2- '1 £-fY d. 6) H¿z.c~\IVV M S 0 $ f-r¿¡". "\.-~ '.£/~~ Œ. 6FL fV\tJi<.d w¿>~ L1S.e/Ut"J s~. CERTIFICATION I, 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 MATERÌALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. /;t~r~ ~z:¿,~ TITLE . ------ /- /9-6/ DATE 4 \ TRUXTUN SURGERY CENTER, INC. e 4260 TRUXTUN AVENUE, SUITE 120 ' " BAKERSFIELD, CA 93309 -, LOCA nON OF EMERGENCY SHUTOFFS 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. Fire/Sprinkler Shut Off Shut off must be done by Bakersfield City Fire Department. Call 911 or 324-4542, 4- ., e - FIRE AND DISASTER GUIDELINES POLICY All personnel shall be prepared to carry out the fire and disaster procedures for the facility. OBJECTIVE To assure implementation of appropriate measures to maintain a safe environment, To educate staff in the principles and practice of handling emergencies in order to decrease ill effects to patients, staff and environs. PROCEDURE 1. All staff shall participate in the following drills: a, Quarterly fire drills, including testing of fire alann system. b. Semi-annual external disaster drills. c. Other inservice as appropriate, A critique of the drill shall be documented. 2. All staff shall receive initial orientation within 15 days of employment to the location and use of the following: a. Exits b. Fire fighting appliances (fire sprinklers, fire hoses, fire extinguishers, etc.) c. Fire alarm devices (fire alarm boxes, smoke and heat detectors) d. Fire and/or smoke barrier doors e. Utility shut-offs (main and auxiliary) f Oxygen location and manifold shut-offs g. Air circulating systems (heating and cooling) h, Auxiliary power source 3. All staff shall observe good Fire Prevention and Life Safety practices: a. By promptly reporting any known fire or life hazard, b. By maintaining clear hallways and exits c. By enforcing the established NO SMOKING RULES d, By the proper disposal of rubbish e . ,. LOCATION OF EMERGENCY SHUTOFFS SERVICE SHUT OFF LOCA nON 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. Fire/Sprinkler Shut Off Shut off must be done by Bakersfield City Fire Department. Call 911 or 324-4542. ,- -, e e EI\.1ERGENCY SYSTEMS AVAILABLE IN THIS FACILITY FIRE ALARM SYSTEM 1, This alerts personnel and notifies the Fire Department: a. Directly or indirectly through TechTime Communications (399-0792). 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 1. These doors divide the facility into sections to prevent the spread of fire and/or smoke. 2. All doors shall be regularly maintained and kept in an operative condition and shall not be obstructed at any time. SMOKE AND REA T 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) tit e .,- EMERGENCY LIGHTING AND POWER SYSTEM 1. To provide automatic restoration of power for emergency circuits within TEN 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) e e 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, e e 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. 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. e e EV ACUA TION DEFINITION 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, e e Evacuation Page 20f2 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 ofthe 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. WHERE 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 PRlORlTIES 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 e e Truxtun Surgery Center INJURY AND ILLNESS PREVENTION PROGRAM POLICY Truxtun Surgery Center will institute and administer ;1 comprehensive and continuous occupational Injury and Illness Prevention Program (IIPP) for all employees. The health and safety of the individual employee, takes precedence over all other concerns. Management's goal is to prevent accidents, to reduce personal injury and occupational illness, and to comply with all safety and health standards. I. RESPONSffiILITY The Safety Officer, is responsible for overall management and administration of the Injury and Illness Prevention Program. He is responsible for implementing the IIPP in his/her work area. A copy of the IIPP shall be available to employees. Questions regarding the program should be directed to himlher. ll. EMPLOYEE COMPLIANCE Employees who follow safe and healthy work practices will have this fact recognized and documented on their performance reviews. Employees who are unaware of correct safety and health procedures will be trained or retrained as described in Section VII. Willful violations of safe work practices (see Appendix A) may result in disciplinary action in accordance with company policies. m. COMMUNICATION Matters concerning occupational safety and health will be communicated to employees by written documentation, staff meetings, formal and informal training and posting. Communication from employees to administrator and/or the safety representatives about unsafe or unhealthy conditions is encouraged and may be verbal or written, as the employee chooses, The employee may use the "Report of Safety Hazard" form in Appendix A and remam anonymous. e e Truxtun Surgery Center , Injury and Illness Prevention Program Page 2 NO EMPLOYEE SHALL BE RETALIATED AGAINST FOR REPORTING HAZARDS OR POTENTIAL HAZARDS OR FOR MAKING SUGGESTIONS RELATED TO SAFETY. The results of the investigation of any employee safety suggestion or report of hazard will be distributed to all employees affected by the hazard or shall be posted on appropriate bulletin boards, IV. INSPECTIONS The Safety Officer will conduct an inspection/investigation to identify unsafe work conditions and practices. 1. Monthly in all work areas; and 2. Whenever new substances, processes, procedures or equipment are introduced into the workplace that represent a new occupational safety and health hazard; and 3. Whenever the Safety Officer is made aware of a new or previously unrecognized hazard. The "Hazard Checklist" or "Hazard Assessment" form in Appendix B shall be used to document these inspections/investigations, V. INJURY AND ILLNESS INVESTIGATION Occupational injuries and illness will be investigated in accordance with established procedures and documented, as described in Appendix C. VI. CORRECTION OF UNSAFE OR UNHEALTHY CONDITIONS Whenever an unsafe or unhealthy condition, practice, or procedure is observed, discovered, or reported, the safety Officer or designee will take appropriate corrective measures in a timely manner based upon the severity of the hazard, Employees will be infonned of the hazard and interim protective measures taken until the hazard is corrected, Employees may not enter an imminent hazard area, without appropriate protective equipment, training, and the prior specific approval of the Safety Officer or designee. e e Truxtun Surgery Center Injury and Illness Prevention Program Page 3 VII. TRAINING A. The Safety Officer or designee sha~l'assure that personnel receive training to familiarize them with the safety and health hazards to which employees under ~ their immediate direction and control may be exposed. B. The Administrator is responsible to see that those under the Administrator's direction receives training on general workplace safety, as well as specific instructions with regard to hazards unique to any job assignment. This training is provided: 1. To all employees and those given new job assignments for which training has not previously been received. The "Employee Safety Checklist" in Appendix D should be used to document this training. 2. Whenever new substances, processes, procedures, or equipment are introduced to the workplace that represent a new hazard; and 3. Whenever the employer is made aware of a new or previously unrecognized hazard. VIII. RECORDKEEPING The Safety Officer or designee shall keep records of inspections, including the name of the person(s) conducting the inspection, the unsafe conditions and work practices that have been identified and action taken to correct the identified unsafe conditions and work practices. These records shall be maintained for three years. The Safety Officer or designee shall also keep documentation of safety and health training attended by each employee, including employee name or other identifier, training dates, type(s) of training and training providers. This documentation shall be maintained for three years. e e Truxtun Surgery Center Injury and Illness Prevention Program Appendix A-I SAFETY AND HEALTJI COMPLIANCE PROCESS Disciplinary measures are progressive and involve four steps: 1. Should a safety and health violation be noted, the administrator is to informally discuss the behavior with the employee, stating the potential dangerous result and outlining the correct procedure, then retrain the employee to ensure understanding. 2. A second violation should generate either a formal verbal warning or a written warning to the employee, depending on the severity. 3. The third infraction results in a formal written warning or suspension of the employee. 4, A fourth violation may lead to employee termination, e e Truxtun Surgery Center Injury and Illness Prevention Program Appendix A-2 ACKNOWLEDGEMENT OF RECEIPT AND REVIlEW OF CODE OF SAFE PRACTICES TO ALL EMPLOYEES: A TT ACHED IS A COPY OF THE CODE OF SAFE PRACTICES. THESE GUIDELINES ARE PROVIDED FOR yOUR SAFETY. IT IS THE RESPONSIBILITY OF TO PROVIDE AND Administrator REVIEW THIS CODE WITH EACH EMPLOYEE. IT IS THE EMPLOYEE'S RESPONSIBILITY TO READ AND COMPLY WITH THIS CODE. THE ATTACHED COPY OF THE CODE OF SAFE PRACTICES IS FOR YOU TO KEEP. PLEASE SIGN AND DATE BELOW AND RETURN ONLY THIS PAGE TO -------------------------------------------------------------.--- I HAVE READ AND UNDERSTAND THE CODE OF SAFE PRACTICES. DATE: NAME: e e Truxtun Surgery Center Injury and Illness Prevention Program Code of Safe Practices Page 1 CODE OF SAFE PRACTICES GENERAL OFFICE It is our policy that everything possible will be done to protect employees, patients and visitors from accidents. Safety is a cooperative undertaking requiring participation by every employee. Failure by any employee to comply with safety rules will be grounds for corrective discipline, Administrator shall insist that employees observe all applicable Company, State, and Federal safety rules and practices and take action as is necessary to obtain compliance. To carry out this policy employees shall: 1. Report all unsafe conditions and equipment to your administrator or safety officer. 2. Report all accidents, injuries, and illnesses to your supervisor or safety officer immediately. 3, Means of egress shall be kept unlocked, well-lit, and unlocked during working hours, 4. In the event of fire sound alann and to fulfill your responsibilities as assigned in fire drill training, 5. Only trained workers may attempt to respond to a fire or other emergency. 6. Exit doors must comply with safety regulations during business hours. 7. Materials and equipment will not be stored against doors or exits, fire ladders or fire extinguisher stations, 8. Aisles must be kept clear at all times. 9. Work areas should be maintained in a neat, orderly manner, Trash and refuse are to be thrown in proper waste containers. 10 All spills shall be wiped up promptly. e e Truxtun Surgery Center Injury and Illness Prevention Program Code of Safe Practices Page 2 12. Files and supplies should be stored in such a manner as to preclude damage to the supplies or injury to the personnel when they are moved. Heaviest items should be stored closest to the floor and lightweight items stored above. 13. All cords running in walk areas must be taped down or inserted through rubber protectors to preclude them from becoming tripping hazards. 14, Never stack material precariously on top oflockers, file cabinets or other high places. 15. Never leave lower desk or cabinet drawers open that present a tripping hazard. Use care when opening and closing drawers to avoid pinching fingers, 16. Do not open more than one upper drawer at a time; particularly the top two drawers on tall file cabinets. 17. Always use the proper lifting technique. Never attempt to lift or push an object which is too heavy. You must contact the administrator when help is needed to move a heavy object. 18, When carrying material, caution should be exercised in watching for and avoiding obstructions, loose material, etc. 19. All electrical equipment should be plugged into appropriate wall receptacles or into an extension of only one cord of similar size and capacity. Three-pronged plugs should be used to ensure continuity of ground. 20, Appliances such as coffee pots and microwaves should be kept in working order and inspected for signs of wear, heat, or fraying cords. 21. Equipment such as scissors, staples, etc" should be used for their intended purposes only and should not be misused as hammers, pry bars, screwdrivers, etc. Misuse can cause damage to the equipment and possible injury to the user, 22. Cleaning supplies should be stored away from edible items on kitchen shelves, 23, Cleaning solvents and flammable liquids should be stored in appropriate containers. 24. Solutions that may be poisonous or not intended for consumption should be kept in well-labeled containers. e e Truxtun Surgery Center Injury and Illness Prevention Program Code of Safe Practices Page 3 CODE OF SAFE PRACTICES PATIENT SAFETY POLICY The Center staff is responsible for providing a safe patient environment. PURPOSE To provide guidelines for patient safety at the Center. PROCEDURE A. Patient will be addressed by name and the procedure personnel will check the patient's identification before transferring the patient to the Procedure Room or dispensing medications. B. All medicated patients on gurneys will have side rails raised. Patients will be instructed not to allow hands, feet, or elbows to extend beyond the confines of the gurney to avoid injury. C. The Registered Nurse verifies the patient's procedure(s) to be perfonned, patient's physician, known allergies, presence of dentures or prostheses, preoperative medications, and orders prior to procedure. D, The consent is checked for completion. E. All wheels are locked on the gurney when stationary. F. The patient is not left alone in the Procedure Room at any time. G, Patients will have a call bell available at the bedside. e e ; Truxtun Surgery Center Injury and Illness Prevention Program Code of Safe Practices Page 4 ELECTRICAL SAFETY POLICY The Center staff will provide patients and personnel protection from electrical hazards. PURPOSE To ensure a safe environment for patient and personnel. PROCEDURE A. All patients requiring the use of any type of electrically operated device will be properly protected, B. Written records of all inspections performed on electrical and electronic system and equipment, including any action taken or recommended, will be maintained on file, C. Annual safety inservice will be provided for all personnel involved in direct patient care. D. All new, used and personal equipment is evaluated prior to use by a Bio Medical technician. E. Annual evaluation of all electrical equipment is completed. F. Non clinical equipment is inspected at regular intervals. This includes, but is not limited to electrical beds, lamps, radios, television and all appliances including microwave ovens. G. Information regarding each item of equipment is readily available in the file cabinet for those responsible for its operation, maintenance and inspection. e e Injury and Illness Prevention Program Code of Safe Practices Page 5 ELECTRO SURGICAL SAFETY POLICY A. All electrosurgical equipment will be inspected by Bio Medical personnel prior to original use and semi-annually B. The RN/GI tech will inspect the Electrosurgical Unit, foot pedal and cord for damage prior to use. C. The RN will perform a pre and post procedure skin assessment to observe skin integrity. D. All patients will be grounded by use of the proper dispersive electrode. E. All employees utilizing the Electrosurgical Unit will receive orientation and inservice routinely on the use of the ESU. PURPOSE To define daily maintenance, preparation and safe use of the electrosurgical equipment. PROCEDURE A. Prior to use on a daily basis, the ESU should be wiped down with a germicidal before use. B. Protect the unit from spills, do not place fluid filled items on top of the ESU. C. The ESU should not be used in the presence of flammable agents (alcohol or tincture based agents). CAUTION: Oxygen supports combustion. When oxygen is being used by way of mask or nasal cannula and the operative site is within close proximity of face, head, ears, or neck, the staff should be aware of the potential for combustion should the ESU be employed, The decision will be made as to whether to discontinue the use of oxygen before using the ESU. D. Before each use, the electrical plug, cord and connections, and the foot switch cord and connections should be inspected for damage. The unit should be removed for repair and tagged if damaged. E. Assure that the ESU electric cord is of adequate length and flexibility to reach the outlet without stress or the use of extension cords. F. Power settings for coagulation and cutting should be as low as possible for each procedure and confirmed orally with the physician before activation. · e T Truxtun Surgery Center Injury and Illness Prevention Program Code of Safe Practices Page 6 G. The patient's skin integrity should be evaluated and observed before and after the ESU use. Particular areas to observe are under the dispersive electrode, under EKG pads and pressure points. H. The patient should not be in contact with any metal table parts. I. The dispersive electrode pad and cord should be inspected before use. All connections should be intact, clean and make appropriate contact. J. The dispersive electrode pad should be placed on the positioned patient on clean, dry skin over a large muscle mass as close to the operative site as possible. Bony prominences, hairy surfaces and scar tissue should be avoided. K. The active electrode cord should be free of loops and twists that can deviate current flow. L. After use, check the area of dispersive electrode pad and note any unusual conditions. M. Document the dispersive pad placement and any other observations on the operative record, . e . Truxtun Surgery Center Injury and Illness Prevention Program Code of Safe Practices Page 7 COMPRESSED GAS CYLINDERS POLICY A. Cylinders of compressed gas of appropriate medical and commercial gases will be ordered, maintained and stored at the Center. B. All cylinders, full or empty, shall be properly secured in holders or chained. C. Empty cylinders will be stored separately from full cylinders. PURPOSE To provide safety measures to be used when utilizing cylinders of compressed gases. PROCEDURE A. Cylinders will be stored in the Gas Storage Room. B. The cylinders will be marked as to contents and secured in the cylinder stands or with chains. - e . ¥ .. Truxtun Surgery Center Injury and Illness Prevention Program Code of Safe Practices Page 8 EMERGENCY BUTTONS POLICY A. Emergency buttons are located in each Procedure Room, patient waiting area, and patient restrooms. B. When the button is activated, the alarm will sound in the A&D room and is audible in the front office. C. All available clinical staff will check the locator panel in the A&D room and respond to the area. PURPOSE To define the method to obtain assistance in case of a patient emergency in the Procedure Room, patient waiting room, or patient bathroom. PROCEDURE A. In the event of an emergency when additional personnel are required, the emergency button will be activated. B. If further assistance is needed, use the emergency page button on the telephone and page for assistance to the area. All available staff will respond to the area identified. Ii, ~~..<'''''...!. -" :\ ~ , / TI!'1!.lli~It1l &1Ul;gery Ceml\1:~It1lc. ·c 4260 Truxtun Avenue, Suite 120 Bakersfield, California 93309 661/327-ENDO OR 327-3636 FAX 327-2888 BilLING 327-3772 ~! e 75t(o S l D~-'-~C IC CITY OF BAKERSFIELD FI EP ARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM iNSPECTION CHECKLIST 1715 Chester Ave., 3rd JFDoor, Bakersfield, CA 9330f-Ø?-- FACILITYNAME~Xt'U;v' 'ScJ~' ~INSPECTIONDATE l()/~, (<...øuù ADDRESS 4 uo \'it.JY.TV~ ~re-- ("2..ð PHONE NO. '3'--7 - 3'- 36 FACILITY CONTACT MI¥W 1&1Q8)G!L- BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES ¡Jt3.J '2.() Section 1: Business Plan and Inventory Program .ß-&.outine D Combined D Joint Agency o Multi-Agency o Complaint ORe-inspection OPERA TION C V COMMENTS Appropriate pennit on hand ?~€ ~L.C-rt= APPLICÆI(~ Business plan contact infonnation accurate WMC-.J u=t.' () ,N 11:f£ ~þ.. ,'- Visible address Correct occupancy V erification 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 Housekeeping Fire Protection Site Diagram Adequate & On Hand (USAsG ~æðJìJ)r; t.J/ AfPUc.lJðltW C=Compliance V=Violation ~r(. CrtJû Any hazardous waste on site?: Explain: DYes ~ Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs, Yellow - Station Copy Pink - Business Copy Inspector: W I NE-~ f~·3~ ¡~Ið CITY OF BAKERSFIELD FIRE l)EP ARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave" 3rd Floor, Bakenfield, CA 9330ÞØ:2- FACILITY NAME-ra-VX'tVrJ Sút<f..f:£è.V ú::~INSPECTION DATE ,ò I~ t !1..t:Juù ADDRESS 4 2..'-D mJ~TVrJ ~re-- (7..ð PHONE NO. '3'-7,>" 316 FACILITY CONTACTM~ Þ'7Q6)@L. BUSINESSID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES -.~~,...,..,.", .... . ., ~. ii~ . r ?5'~ ro ~ ,.,. \D'2.' '-C; L· \ C. ¡J[3¿J "2..0 Section 1: Business Plan and Inventory Program :!i-Routine o Multi-Agency o Complaint o Combined o Joint Agency ORe-inspection OPERATION C V COMMENTS Appropriate pennit on hand ?(~é CCÞ"'IPLC-.e APf"cA"íId^i j Business plan contact infonnation accurate " W..fC~ Ree' f) IN ~. 1lAt:Þ 1(.,.. ~--,. \~.,_. . ""'. . Visible address ., . ,~.' . " .>\ I ¡, Correct occupancy / '. " §.... . Verification of inventory materials / ,.r'~ I"~ ,'" , " /' '- '''-, 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 : Emèrgency procedures adequate Containers properly labeled . Housekeeping Fire Protection Site Diagram Adequate & On Hand ?Lé--c. stE f?æ.ðJ,4}t; ;:;,7 AfPU( 4T7orJ C=Compliance V=Violation Any hazardous waste on site?: Explain: o Yes ~ Questions regarding this inspection?, Please call us '.~t (661) 326- 3 97 9 " '. , . ~1\Jt( ~ White - Env. Sv~' Yellow - Station Copy: Pink - Business Copy Inspector: W ' I\! IE- '}¡ ~ , l_. J-"¡Lru'N CHEMICAL LOCATION 1 ~ tif)rJ L~pa.C-$>ø COMMON NAME CAS # . CITY OF BAKERSFIELIa OF:PItE OF ENVIRONMENTAL SftVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION 200 201 CHEMICAL LOCATION CONFIDENTIAL (EPCRA) 203 GRID # (optiona/) A-z(L 207 FIRE CODE HAZARD ClASSES (Complete if requested by IoceIIire 209 TYPE PURE PHYSICAL STATE o s saUD FED HAZARD CATEGORIES (Check aU that apply) ANNUAL WASTE AMOUNT o 1 FIRE UNITS' STORAGE CONTAINER (Check aD that apply) o a ABOVEGROUND TANK o b UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEEL DRUM o m MIXTURE Dyes D No (one form per material per buddIng or a18a) Page of Dyes DNo 202 204 ,.: ,."""," D Yes D No 206 If Subject to EPCRA, refer to instrUctions I 210 ¡ 212 CURIES 213 , D w WASTE 211 RADIOACTIVE 215 ! i i 216 I ; 219 STATE WASTE CODE 220 o I LIQUID ~GAS ¿4~ 221 DAYS ON SITE 222 214 LARGEST CONTAINER D q RAIL CAR D r OTHER 223 o 2 REACTIVE o 3 PRESSURE RElEASE o 4 ACUTE HEAlTH o 5 CHRONIC HEAlTH STORAGE PRESSURE D a AMBIENT ~ ABOVEAMBIENT D ba BELOW AMBIENT 224 STORAGE TEMPERATURE 91& AMBIENT o 88 ABOVE AMBIENT o ba BELOW AMBIENT o c CRYOGENIC 225 226 227 DYes oNo 228 229 2 230 231 Dyes 0 No 232 233 3 234 235 D Yes D No 236 237 4 238 239 o Yes D No 240 241 5 242 243 DYes DNa 244 245 217 7SÒ o gø GAL ~ CUFT . If EHS. amount must be in Ibs, 218 AVERAGE DAILY AMOUNT o Ib LBS 0 In TONS UPCF (7/99) MAXlWM DAILY AMOUNT De PLASTlCINONMETALUC DRUM Of CAN o 9 CARBOY o h SILO o FIBER DRUM OJ BAG Ok BOX ~LINDER o m GLASS BOTTLE o n PlASTIC BOTTLE 00 TOTE BIN o P TANK WAGON S:\CUPAFORMS\OES2731.TV4.wpd . CITY OF BAKERSFIELIa OFfttE OF ENVIRONMENTAL SfttVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION EW DADO 200 (one fann per material per building or area) Page of ,. CHEMICAL LOCATION J ~ 5' I f)~ Tvt ~-() - GAs ~ 2011 CHEMICAL LOCATION CONFIDENTIAL (EPCRA) GRID' (optional) o Yes 0 No 202 204 FACILITY 10. ð)(~~ , CHEMICAL NAME 201 COMMON NAME CAS' -209 FIRE CODE HAZARD ClASSES (Canplete if requested by local ftt8 210 ; I ! TYPE OpPURE o m MIXTURE o w WASTE 211 RADIOACTIVE DYes ONo 212 CURIES 213 : i ¡ i PHYSICAL STATE o I SOUO 01 UQUID OgGAS 214 LARGEST CONTAINER 'z...S- I 215 ¡ i FED HAZARD CATEGORIES o 1 FIRE o 2 REACTIVE o 3 PRESSURE RELEASE 04 ACUTE HEAl TIi o 5 CHRONIC HEAl TIi 216 ! (Check all that apply) ANNUAL WASTE 211 I MAXIMUM 7S''? 218 AVERAGE 219 STATE WASTE CODE 2201 AMOUNT DAILY AMOUNT CAlLY AMOUNT I UNITS' o ga GAL ~FT o Ib LBS o In TONS 221 DAYS ON SITE 222 ¡ I . If EHS. amount must be In Ibs, i i STORAGE CONTAINER o a ABOVEGROUND TANK De PLASTlCINONMETALlIC DRUM o I FIBER DRUM o m GLASS BOTTLE o q RAIL CAR 223 (Check all that apply) Db UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEEL DRUM Of CAN o 9 CARBOY o h SILO OJ BAG Ok BOX ~NDER o n PLASTIC BOTTLE 00 TOTE BIN o P TANK WAGON o r OTHER STORAGE PRESSURE o a AMBIENT ~ ABOVE AMBIENT o be BELOW AMBIENT 224 STORAGE TEMPERATURE 230 231 DYes 0 No 232 233 3 234 235 o Yes 0 No 236 231 238 239 DYes 0 No 240 241 L-%4£l/ .#/ð£ OLÁ / ' . 4d~ ~~/Ø/t~ /0- 3/- cJ UPCF (7/99) S:\CUPAFORMS\QES2731.TV4.wpd