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Home My WebLink AboutBUSINESS PLAN 7/19/2007 Ït-t.>øper·â,tê Per ~. Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF ·PERMIT ON REVERSE SIDE 1'I11s pennlt Is Issued for the following: It! Hazardous Materials Plan o Underground Storage of Huardous MaterIals , 0 Risk Management Program o Hazardous Waste On-Site Trætment Permit ID I:: 015-000-000521 Issued by: ." ~ 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: Issue Date . June 30, 2003 ~-_.-_.__._--- - ---_._._~. PerDl.Ït t'" , ' o Operate Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE MARK A KINNSCH DMD DENT This permit is issued for the fo~lowlng: !!¡Hazardous Materials Plan round Storage of Hazardous Materials agement Program " Waste PERMIT ID# 015-021.000521 LOCATION 6001 Issued by: Expiration Date: *~ ph Huey, ffice of ental Servi es June 30, 2000 Bakersfield Fire Department OffiCE OF ENVIRONMENTAL SER VICES 1715 Chester Ave" 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 Approved by: /') ~ ì õ ~ ! ~ I lilVliY1Y SIT E DI"RA~1 0 3us::l!!SS Name: l" L fi. L"i lV l.L~r FACjlTY DIAGRArv1 ,(;1ÆflJL ~(V-(IV¡¡/S{]lfJ1)1rï/ VE~?ll'iMf-l~ ( - '\r!!a Map :r-L of V- !vttf-eJ{ !tz€PIMl- PIff2f-) BGþL¡-]) Name of '\r!!a: Sill T€- 410, ÇRJ A, No:''':~ -- _..........-..a...,~ ""-A.4..~,..... vmrê~ ~~1~¥3' lOlilPiJriir þtAAf' r AL 17 AS o 0 ¡ n ÿ r 1 .. J \ ( o o BUSINESS ~,g~ I g~p~,AiA ~Õ~~D ~ACH S, D~ or WALL . JfJJ~mó~G R~ , LAB ... Œ!J<9ElOW) r---------- I - -- ~-B----------- --------, I 12 A5 j ~ ~._." ,/" 111 Y 11Y 1 r r L 1"1. L -, 1 Y 1.L~..l SITE DLtJìRATv1 ~ FACi'TY DIAGRAÑ1 0 3us :':1!!SS Name: f1A-(2/L 1/-, {-1/J¡tkÇ¡!j-/¡ P/l1'Y VflvJJ1¿ {Uff, A, No:","=~ Ar!!a Map # 7- ' or 7- _ tVlfJ?C'f MKtl )rÆj_.- r/if-r-- ~lame of Ar'!i!: B L-- Þ t;- C!- :J? . & lLWd .~ [ . .Ñ ":..0_ _ ¡; .. , . O.N__ N. VAtltM ofRct$ --": Ñ _. ~ ----ow .. 0 " . ffFac, --- c -.. : '1 . .. . KINNSCH DMD DENTAL CARE MARK A SiteID: 015-021-000521 Manager LAINIE TORIGIANI Location: 6001 TRUXTUN AVE 490 City BAKERSFIELD BusPhone: (661) 322-9242 Map 102 CommHaz High Grid: 34A FacUnits: 1 AOV: CommCode: BFD STA 11 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title MARK A KINNSCH / OWNER LAINIE TORIGIANI / DENTAL ASST Business Phone: (661) 322-9242x Business Phone: (661) 322-9242x 24-Hour Phone (661) 587-2055x 24-Hour Phone (661) 589-7197x Pager Phone (661) 333-1360x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact LAINIE TORIGIANI Phone: (661) 322-9242x MailAddr: 6001 TRUXTUN AVE 490 State: CA City BAKERSFIELD Zip 93309 Owner MARK A KINNSCH/AMPARO M KINNSCH Phone: (661) 322-9242x Address 6001D TRUXTUN AVE 490 State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ENr~p ~ ~ ~ ~ ~ Zia' Based an my ino,r!iry of those individuals respensibie 'or attaining the information, !certify under penalty o'r law that I have personally examined and am tamiliar with the information submitted and believe the information is true, accurate, and complete. Signature Date -1- 07/12/2007 F KINNSCH DMD DENTAL CARE MARK A SiteID: 015-021-000521 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE F P IH G 562.00 FT3 Hi OXYGEN F P IH G 562.00 FT3 Low CARBON DIOXIDE F P IH G 425.00 FT3 Min HELIUM F P IH G 40.00 FT3 Min -2- 07/12/2007 -3- 07/12/2007 F KINNSCH DMD DENTAL CARE MARK A ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME NITROUS OXIDE Location within this Facility Unit S CTR SiteID: 015-021-000521 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map. Grid: CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TPure _~Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Co281100rFT3 Daily 562100m FT3 I Daily 281~OOe FT3 - r~~t~xL~ua t_:Vi~irViv~lvl~ %Wt. RS CAS# 100.00 Nitrous Oxide No 10024972 riAGAtCL H~Jt5Jb1~1L"1V1b TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME OXYGEN Location within this Facility Unit S CTR STATE TYPE PRESSURE _ GasPure -Above Ambient Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 7782-44-7 TEMPERATURE CONTAINER TYPE Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 281.00 FT3 562.00 FT3 281.00 FT3 riHGl~KL V U .7 1. V1~1r V1V L" 1V 1.7 %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 Yf.E~GEitCL 1~.7 ~ ~ b ~1~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No Noj Curies F P IH / / / Low -4- 07/12/2007 F KINNSCH DMD DENTAL CARE MARK A SiteID: 015-021-000521 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME CARBON DIOXIDE Days On Site 365 Location within this Facility Unit Map: Grid: S CTR CAS# 128-38-9 ~GasATE TPureE ~AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 425.00 FT3 425.00 FT3 425.00 FT3 rlr-~~EUC1.1VUa ~VriYV1V~iV1~ %Wt. RS CAS# 100.00 Carbon Dioxide No 124389 riAGF~tCL Y,J~t',~b1~1~1V 1 7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME HELIUM Days On Site 365 Location within this Facility Unit Map: Grid: INT GAS STORAGE RM CAS# 7440-59-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TPure ~_Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Con80100rFT3 Daily M40100m FT3 I Daily 240r00e FT3 11HGL~ICLV U.7 1.V1~lYV1VL" 1V 1.7 oWt. RS CAS# 100.00 Helium No 7440597 riEiGtit'CL 1jbJ~5,71~1tS1Vl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -5- 07/12/2007 F KINNSCH DMD DENTAL CARE MARK A SiteID: 015-021-000521 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 02/22/2000 FOLLOWING DETECTION OF LEAK OR FAILURE OF BACKUP SYSTEM THAT CAN NOT BE SAFELY RESOLVED (SHUT OFF) OR EMERGENCY DETERMINED SUCH AS FIRE: DELEGATED TRAINED EMPLOYEE OR OWNER WILL CALL 911 AND EXPLAIN EXISTENCE OF N20/02 GAS AND REQUEST ASSISTANCE. IF FACILITY PHONE IS NOT ABLE TO BE USED WILL GO TO OTHER OFFICE NEARBY. = Employee Notif./Evacuation 01/07/1990 THE OWNER OR DELEGATED EMPLOYEE WILL DETERMINE EMERGENCY, AND NOTIFY ALL EMPLOYEES VIA INTERCOM OR VERBALLY AND EVACUATE THE PATIENTS FOLLOWING ESCORT. Public Notif./Evacuation 02/22/2000 ALL ROOMS CHECKED BY OWNER, OR DELEGATED EMPLOYEE, OF IMMEDIATE FACILITY; SECOND EMPLOYEE WILL ADVISE SURROUNDING OFFICES. ALL TO EVACUATE AS NECESSARY TO N SIDE OF PARKING LOT. Emergency Medical Plan 01/07/1990 FOLLOWING CALL TO 911 (PARAMEDICS/AMBULANCE) INJURED PERSONS TO BE TRANSPORTED TO MERCY HOSPITAL, 2 MILES AWAY. -6- 07/12/2007 F KINNSCH DMD DENTAL CARE MARK A SiteID: 015-021-000521 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 04/07/2006 ~ TRAINED EMPLOYEE ESCORTS SERVICE PERSON (GAS TANKS) VIA REAR ENTRANCE (EAST) AND SUPERVISES REMOVAL/INSTALLATION OF TANKS, SECURED BY CHAIN IN THE ONE-HOUR FIRE ROOM. ALL TANKS SHUT-OFF AND CAPPED WHEN TRANSPORTED. Release Containment 08/27/1992 FAIL SAFE FAN EQUIPPED WITH ALARM TO EXHAUST AND PREVENT GAS BUILD UP. Clean Up 02/28/2007 MINIMAL CLEAN-UP DUE TO INHERENT NATURE OF GASES; IF EXCESSIVE - UNUSUAL RELEASE, THEN ACTIVATE ALL AREA VENTING FANS TO EXHAUST. V1.11C1 1CC5VUL l:C til:L1VC1L1V11 -7- 07/12/2007 y ~ F KINNSCH DMD DENTAL CARE MARK A SiteID: 015-021-000521 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .7~JC C~1dl LldGdI U.S" Utility Shut-Offs 12/13/2006 A) GAS - NONE B) ELECTRICAL - BATHROOM C) WATER - COMPRESSOR CLOSET CEILING ABOVE LAB SINK D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 02/02/2007 PRIVATE FIRE PROTECTION - CEILING SPRINKLER IN NITROUS RM, FIRE EXTINGUISHERS, AND FIRE ALARM FOR ENTIRE BLDG WITH AN ALARM UNIT IN FRONT OFFICE HALLWAY. FIRE HYDRANT - 75FT FRONT N SIDE OF BLDG. Building Occupancy Level 12/27/2006 6 EMPLOYEES -8- 07/12/2007 ~. ., F KINNSCH DMD DENTAL CARE MARK A SiteID: 015-021-000521 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 12/13/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SiJMMARY OF TRAINING PROGRAM: BI-WEEKLY REVIEW/REHERSAL OF PROCEDURES OUTLINED IN SECTION 6 BY OWNER FOLLOWING AN ESTIMATED 2-HOUR DEMONSTRATION/ REHERSAL/QUIZ AND REVIEW WITH EACH EMPLOYEE. FIRE DEPT CONSULTATION WOULD BE REQUESTED INITIALLY AND AS AVAILABLE, INSTRUCTIONS AS LISTED IN HAZARDOUS MATERIALS MANAGEMENT PLAN ALSO REVIEWED. rayc ~ nciu Lvi ru~.uic u~c Held for Future Use -9- 0~/12/200~ Jul 18 07 10:54a ROSS CHIROPRACTIC CLINIC INC Manager LEONARD S ROSS Location: 6001 TRUXTUN AVE A-120 City BAKERSFIELD CommCode: BFD STA 11 EPA Numb: p.1 SitelD: 015-021-0029&7 BusPhone: {661} 864-1100 Map 102 CommHaz Minimal Grid: 34A FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title LEONARD S ROSS DC / OWNER / Business Phone: (661) 864-1100x Business Phone: ( ) - x 24-Hour Phone (661) 342-0436x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact LEONARD S ROSS Phone: (661) 864-1100x MailAddr: 6001 TRUXTUN AVE R-120 State: CA City BAKERSFIELD Zip 93309 Owner LEONARD S ROSS DC Phone: (561) 864-1100x Address 5001 TRUXTUN AVE A-120 State: CA City BAKERSFIELD Zip 93309 Period to Tota1.ASTs: = Gal Preparers TatalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ~Iq l ~~ ~ ~ ~ ~ ~'~~~ , . ~, ~.fr e~i: ._.._. . -1- 07/16/2007 UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1: Business Plan and Inventory Program ~" Prevention Services B A F. R S,P 1 p 900 Truxtun Ave., Suite 210 F/AE Bakersfield, CA 93301 aArui - Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY N - ~ INSPECTION DATE INSPECTION TIME ~ i 2o~ie/t~-~C~ C,c.. ~ T L ~ ~`G .. /Z ' Zf " Zo6 ~ b~ r ra I ~ ADDRESS ~trS ~ / Z ~ - PHO~NjE NO. ~ ~'- ~ NO OF EMPLOYEES W I u. J t TJ FACILITY CONTACT ~ L ~o /20~ BUSINESS ID NUMBER 15-021- 4Z7Zij~ 7 ~ ` Section 1: Business Plan and Inventory Program ~ j ~~ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V- ( C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND , ~ ~O~ I~ ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATIDN OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY I~ ^ VERIFICATION OF HAZ MAT TRAINING I~ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED I~ ^ HOUSEKEEPING ~I ^ FIRE PROTECTION I,~ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ;":YES ^ NO EXPLAIN: ti~~~~-~~ ~ Gf QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1s' In /Shift of Site/Station # d White -Prevention Services Yellow -Station Copy Pink -Business~Copy ~ FD 2155 (Rev. 09/05 ` UNIFIED PROGRAM INSPECTION CIiECKLIST 4:c'?#:u''..."+.~,„";..~~~'"c~4k*YaFsr.~c°r'"::I:YE.FJ":<k,.-_:.m. .li. .: 2fi7 ee>a+v.?-: ..r.Y2.W.: i::r. ..:..~ ' SS'^S ' ..i ~n'4:k.3.S :e...,+42. iY$'?' SECTION 1: Business Plan and Inventory Program ~~~~ ~Rrr FACILITY NAME NSP CTION ~ N~e.a ~ o% lS~~-J ADDRESS~® ~ ^~ ~ ~~ ~~ ) ~~~_~~~ OOFEM YEES FACILITY CONTACT ~~ L~~~~ ~ o,~, ~; ~~.,~ ~ USINESS ID NUMBER ,5-~z,- s-Z 1 Section 1: Business Plan end Inv®ntory Program f ~ y ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (C=Compiiance~ OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSinQSS 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 ^ VERIFICATION OF ABATEMENT SUPPLIES AND PR CEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE 8 ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 \ ~ , `, ,~, v~/~ , ~n~~ P~,T- q ~ ~ Inspector (P~e Print) Fire Prevention / 1g' In /Shift of SRe/Station # Btuiness Site/School ite R e (Please Print) White -Prevention Services Yellow -Station Copy Pink - Buaineas Copy FD2049 (Rev. 02/05) ^ YES ~NO BAKER8FIELD FTRE DEPT Prevention 8ervlcea 900 TYuxtun Ave.. Suite 210 Bakersfield. CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-21~tf~+? DA NSPECTION TIME `fR~ r ~ ROSS CHIROPRACTIC CLINIC INC ________________________ SiteID: 015-021-002967 + Manager LEONARD S ROSS DC BusPhone: (661) 864-1100 Location: 6001 TRUXTON AVE A-120 Map 102 CommHaz Minimal City BAKERSFIELD Grid: 34A FacUnits: 1 AOV: CommCode: BFD STA 11 SIC Code: EPA Numb: DunnBrad: F__________________________P=====_____ __+______________________________=_______~- Emergency Contact / Title Emergency Contact / Title LEONARD S ROSS DC / OWNER / Business Phone: (661) 864-1100x Business Phone: ( ) - x 24-Hour Phone (661) 34.2-0436x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards.: React Contact LEONARD S ROSS DC Phone: (661) 864-1100x MailAddr: 6001 TRUXTON AVE A-120 State: CA City BAKERSFIELD Zip 93309 Owner LEONARD S ROSS DC Phone: (661) 864-1100x Address :~ 6001 TRUXTON A~IE A-120 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 Based on my inquiry of those individuals responsible for obtaining the information, I certify under p Ity of law that 1 have personally exami d a d am familiar with the information su fitted nd believe e i formation is true, accurate, d,~omgle ~ ~~~7~'~ re Date ~N~ Ap ~0~20 06 I ~ I -1- 03/13/2006 + KINNSCH DMD DENTAL CARE MARK A ______________________ SiteID: 015-021-000521 + Manager Location: 6001 TRUXTUN AVE 490 City BAKERSFIELD CommCode: BFD STA 11 EPA Numb: BusPhone: (661) 322-9242 Map 102 CommHaz High Grid: 34A FacUnits: l AOV: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title MARK A KINNSCH / OWNER LANIE TORIGIANI / DENTAL ASST Business Phone: (661) 322-9242x O Business Phone: (661) 322-9242x 24-Hour Phone ~ 24-Hour Phone (661) 589-7197x Pager Phone (~~ )/f 33 ~~Qx pV Pager Phone ( ) - x Hazmat Hazards: Fire Press - ImmHlth Contact LANIE TORIGIANI Phone: (661) 322-9242x MailAddr: 6001 TRUXTUN AVE 490 State: CA City BAKERSFIELD Zip 93309 Owner MARK A KINNSCH/AMPARO M KINNSCH Phone: (661) 322-9242x Address 6001D TRUXTUN AVE 490 State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo- Emergency Directives: ~ ` ~ 5~~-255 ~ J i/ PROG A - HAZMAT ENT'D APR 0 7 2006 based on my inquiry of those individuals responsible for obtaining the information, 1 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. ~' 03?~ Signatur ___. Date 5~s .Q~"r~4eHED (~/ISioNS Sys: r, r, 8,9 -1- 03/13/2006 >~ • - 1 UNIFIED PROGRAIIA INSPECTION CHECKLIST ....•.u. _._-__~~. _~._.._~_-..___----- - - ___ SECTION 1 Business .Plan and Inventory Program Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93~~ ?.~j ?~~5 Tel: (661)_326-3979 __ _ _ FACILITY NA^~~~ WSPECTI N DATE INSPECTION TIME ADDRESS ~'~ PHONE No. No. of Employees FACIL ITYCONTACT Business ID Number 15- l`/C-~ Section 1: Business Plan and Inventory Program ~~~ (,~ ^ Routine ~6ombined ^ Joint Agency ^MultI-Agency ^ Complaint ^ -ins n C V \ V=wo atlonnce } OPERAT{ON COMMENTS ~ ~ ^ ^ APPROPRIATE PERMIT ON HAND ` ^ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ ^ VISIBLE ADDRESS ^ ^ CORRECT OCCUPANCY ^ ^ ' VERIFICATION OF INVENTORY MATERIALS ~ .~~ ~ .Fi1.X~~ ^ ^ VERIFICATION OF QUANTITIES S' /~ w , lT~~. ^ ^ .VERIFICATION OF LOCATION ^ ^ PROPER SEGREGATION OF MATERIAL ^ ---- ^ -- VERIFICATION OF MSDS AVAILABILITYE ---- -- ------- ----- -- -- -- -. ..-- - ...-.. - .. --- - .. _ ._ ... - - - - - - ^ ^ VERIFICATION OF HAT MAT TRAINING I ^ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~~~ ^ ^ EMERGENCY PROCEDURES ADEQUATE ^ ^ CONTAINERS PROPERLY LABELED p _ _--- _ ..---....- ~[? 1-(~)/tnGO JIJ I~S~ -- _-- - - ^ ^ HOUSEKEEPING ^ ^. FIRE PROTECTION ~ ^ ^ SITE DIAGRAM ADEQUATE ~ ON HAND ANY HAZARDOUS WASTE ON SITE?: L~i.ES ^ NO EXPLAIN: s/~AS ~ a- <tR-G~ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (,56~~ 326-3979 _v.1_e ^r~ S _ _ _ - ---Inspector (Please Prinq_-- - - -- _-• -_ -- - - --~ -- -Fire Prevention 1st-In/Shift of Site _ . _..__ White -Environmental Services Y911oW - Stetron Copy usiness ite esponslble Pa (Plea Print) a Pink -Business Copy ;= ~. B @ R S F I U P/RB ~RrM r •. h:.y R. ~..d ~~. CITY Ol~ 13AkERSFIELD ~.e OFFICE OF ENVIRONMENTAL SERVICES E 1715 Chester Ave., CA 93301 (661) 326-3979 _ nrd HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION ~IEW ^ ADD ^ DELETE ~ REVISE - -----.....----------------..__.._....__.._. _...... . _ .. 200 I. FACILITY It~IFARMATION (one loan permatarial per building orarea) Page _ of BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) CHEMICAL LOCATION ~ 20t CHEMICAL LOCATION ~hr~ rQ~ ~(YjjC- ~jZQ,l"fY~i\ CONFIDENTIAL (EPCRA) FACILITY ID # ~ c f ~ I i . I I t( MAP p (optionan 203 GRID # (optionaQ }I '~__~ .4.4y _I ~ i' ~1.__.1...__... _......- ._ .....__..._.__... .. ...-.__..___._-_.____.. ...... ..... .. ..... .._. .____.... ._ - .-_ .... .......... . _. .___. _ I ~ II. CiiEMiCAL INFORMA710N CHEMICAL NAME (t~~ w ..~ ~e~. COMMON NAME ^ Yes ^ No 202 205 'TRADE SECRET ^ Yes ^ No 206 1! Subjed to EPCRA, refer to instructions 207 - - ------ ------------- ----- - - EHS' ^ yys ^ No 208 CAS # 209 •If EHS is'Yes,' all amounts below must lte in lbs. j FIRE CODE HAZARD CLASSES (Complete if requested by local fre chief) ~ ~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ - 210 . _ .. _ . ' TYPE . ~.... ~.`_. ^ D PURE ^ m MIXTURE ~ WAS-= .. ........ . _. CURIES R-.UIOACTIVE ^ Yes ^ No 2t2 2t3 PHYSICAL STATE ^ S SOLID ~i-LIOUID ^ y GAg 214 ~RGEST CONTAINER f" J 2t5 FED HAZARD CATEGORIES ^ t FIRE ^ 2 REACTIVE ^ 3 PRES:3;RE F:ELEG .SE ^ A:U`E HEALTH ~'SCHRONIC HEALTH 2t6 (Check all that apply) , I ANNUAL WASTE 2t7 ;d4XIMh'M 218 AVERAGE 2t9 i STATE WASTE CODE ~ 220 AMOUNT DAILY AMOUNT ~ DAILY AMOUNT , i UNITS' ~ GAL ^ d CU FT ^ Ib LBS ^ to TONS 221 t DAYS ON SITE 222 ' If EHS, amount must be in lbs. j STORAGE CONTAINER ^ a ABOVEGROUND TANK PLASTIC/NONMETALLIC DRUM ^ i FIBER DRUM ^ m GLASS BOTTLE ^ q RAIL CAR 223 (Check all that apply) ^ b UNDERGROUND TANK ^ f CAN ~, j BAG ^ n PLASTIC BOTTLE ^ r OTHER ^ c TANK INSIDE BUILDING ^ g CARBOY ^ k BOX ^ o TOTE BIN ' j i ^ d STEEL DRUM ^ h SILO ^ I CYLINDER ^ p TANK WAGON ' STORAGE PRESSURE I ---- - ~ gMBIENT ^ as ABOVE AMBIENT ----- . ...-- - .. --- ^ ba BELOW AMBIENT 224 STORAGETEMPERATURE C~gMB1ENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT ^ c CRYOGENIC 225 %WT.' : '''`''''.' ::'_''-' ` . HAZARDOUS COMPONENT EHS I '• CAS # ' i 1 I 226 ~ 227 ^ Yes ^ No 228 229 I ! 2 230 -._--_.1 I----•----- -- -------.. 231 j ~ ^ Yes ^ No 232 - 233 i ~ 3 234 i i ~ _ : _ _. _. . _..._-..... - 235 ^ Yes ^ Na 236 237 --~--...... I i 4 1 238 ... -. ... ....---.__...--------~------- 239 ~ ~ ^ Yes ^ No 240 241 . - 5 242 243 i ^ Yes ^ No 244 245 III. SIGNATURE .._ PRINT NAME 8 TITLE OF AUTHORIZEb~COMPANY REPRESENTATIVE ~ ~~ ~ ~~~ ~~~ ~ ~ SIGNATURE __ ~ DATE 246 UPCF (7199) S:ICUPAFORMS\OES2731.TV4.wpd t 1 ~ ~_, - i, ~e~ ` ~ ! r ~' ~ has an appointment with ~ ,~" ~~ ~ ~ ~ Ross. Chiropractic Clinic;'Inc: ~ r `LEONARD S.~ROSS, D.C., Q.M.E. 6001,,-A Truztori Ave., Suite 120 ~ Bakersfield, CA 933'09 ~ ,. ~ ~ ~ _ (661) 864-1100 '° J ^ MON ~ ^ TUES ^ WED D THURS ^ FRI ^ SAT ~ ~A.M. .I at/ PM ~ No charge will be made for cancellation of appointment if a 24-hour notice is given. ~ ~ UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME INSPECTION DATE INSPECTION TIME ADDRESS PHONE No. No. of Employees __ _~ G' ~ _____~_~-cam ~u~/ ---•_~_,~_ ~ _ ~ `f~ d -------- ~?..~ -12 ----~.------- FACILITYCONTACT ~ Business ID Number ~,yJ~ ~ ~ ti ~ GZ `~ 15-021- 00452 Section 1: Business Plan and Inventory Pn~gram C'1'Routine ^ Combined O Joint Agency ^MuIti-Agency ^ Complaint ^ Re-inspection C V ^ \V=Voatioinncel OPERATION APPROPRIATE )PERMIT ON HAND COMMENTS CX ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE l~ ^ VISIBLE ADDRESS l~ ^ CORRECT OCCUPANCY L° J ^ VERIFICATION OF INVENTORY MATERIALS J ~ / L7 ^ VERIFICATION OF QUANTITIES y ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL L~J ^ VERIFICATION OF MSDS AVAILABILITYE ^ VERIFICATION OF HAT MAT TRAINING ^~^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES Ifi ^ EMERGENCY PROCEDURES ADEQUATE l~ ^ i~ ^ ~~^ L7 ^ CONTAINERS PROPERLY LABELED HOUSEKEEPING FIRE PROTECTION SITE DIAGRAM ADEQUATE H~ ON HAND ANY HAZARDOUS WASTE ON SITE?: OYES LJ IVC~ EXPLAIN: QUESTIONS - ARDING TH SPECTION~ PLEASE CALL US AT ~B6'I ~ 326-3979 0~3~ Inspector Badge No. White • Environmental Services Yellow • Station Copy _ l usiness ite Re pon Ibte Paq~ I ~~ Pink -Business Copy i:, ./ 0 ,\ MARK A KINNSCH DMD DE'.L CARE . SiteID: 015-021-000521 Manager : Location: 6001 TRUXTUN AVE 490 City BAKERSFIELD 'ò 't~~~ BusPhone: t'~ Map : 102 ~v Grid: 34A (661) 322-9242 CommHaz : Low FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 11 EPA Numb: SIC Code: DunnBrad·: Emergency Contact MARK A KINNSCH Business Phone: 24-Hour Phone : Pager Phone : / Title / OWNER (661) 322 - 9242x (661) 664-0879x ( ) - x Emergency Contact LAINIE TORI GIANI Business Phone: 24-Hour Phone : Pager Phone : / Title / DENTAL ASSISTAN (661) 322-9242x (661) 589-7197x· ( ) - x Hazmat Hazards: Fire Press ImmHlth Period : Preparer: Certif'd: ParcelNo: to Phone: (661) 322-9242x State: CA Zip : 93309 Phone: (661) 322-9242x State: CA Zip : .93309 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Contact : MailAddr: 6001 TRUXTUN AVE 490 City : BAKERSFIELD Owner Address City MARK A KINNSCH/AMPARO M KINNSCH : 6001D TRUXTUN AVE 490 : BAKERSFIELD Emergency Directives: ~. M,qrkA - Kinn",,..hmm [»© Uì®U'®[Q)~ tOOEï(iff1f ~Ûl®~ ~ ~®V® (ìv~ C7 ~g 00'II3) 0 !i'@vi@w®©J ~U"ù® ~~©h®©J 1(ij~ta1F(QJ©~$ m~~®li'ita1~$ mtalúîta1@®~ M~fk. A. Klnnsch, DMD M~fi'1t ~~~ g©JU'D:ENTAL CARE ©lfi1(QJ ~M~ ¡~ @i©í1@ W¡%~ (~,O, ~lnaro) ®~y ooú'rr®©íü@G']$ OOi'ì)$'ß¡~lB~® lID ©@m[QJ!®~® ~1iW21 ©mU'®©t M®~~ ~~m®úî~ [QJ~@lfìl1Ï©1i' Ml? g®ci~i~~. ~?L-W $i@'lEiiWo __ CJ1-r b 'Ð? ~to -1- 09/09/2003 - . CITY OF BAKERSFIELD FBRE DEPARTMENT OFFICE OF ENVIRONMENT AIL SERVICES UNIFIED PROGRAM HNSPECTHON CHECKLIST 1715 Chester Ave., 3rd l~loor, Bakersfield, CA 93301 fACILITY NAMEj<;IV^,$~ ÒØ1µ 0e-~/ INSPECTION DATE Il--/~ --ot; ADDRESS /" no I - , r.u. y~ . ~ (,1.40 PHONE NO, ~ (:.(:, - 9 z L/z- FACILITY CONTACT I-A-I/I/r e I (J71. I ~ I~, BUSINESS ID NO. 15-210- 0 z:.., ~ -CJúú ,-z..., 4 INSPECTION TIME \< M;~ NUMBER Of EMPLOYEES ~ Section I: ~Routine Business Plan and Inventory Program o Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS ,/ Appropriate pennit on hand v' . . Business plan contact infonnation accurate ( LA' /IV . e To"')'~' .\.."........." el.-- . -,I - s-f(~ - -=¡ I Cj?- , 0 Visible address 'if COlTect occupancy vi Verification of inventory materials ,/ Verification of quantities :/ Verification of location / Proper segregation of material ./ Verification of MSDS availability ~ . .~ Verification of Haz Mat training ,/ V Verification of abatement supplies and procedures V .. \ ./ Emergency procedures adequate "'" Containers properly labeled vi' Housekeeping ./ Fire Protection / Site Diagram Adequate & On Hand V C=Compliance V=Violation AllIY hanzardous waste on site?: Explain: r:J Yes ~þ9p Business Site Responsible Part While· Env. Svcs, Yellow· Station Copy Pink - Business Copy Inspector: C eÞnp¡.AJ~·/Iy· Questions regarding this inspection? Please call us at (661) 326-3979 .;~.-. -- ¡-~ - R~·rEIVED E FES 1 5 2000 - SiteID: 215-000-000521 MARK A KINNSCH DMD DENTAL C BusPhone: Map : 102 Grid: 34A Manager : Location: 6001 TRUXTUN AV~/ City BAKERSFIELD CommCode: BAKERSFIELD STATION 11 EPA Numb: SIC Code: DunnBrad: (805) 322-9242 CommHaz : Low FacUnits: 1 AOV: Emergency Contact / Title Emergency Contact / Title MARK A KINNSCH / OWNER LAINIE TORIGIANI / DENTAL ASSISTAN Business Phone: (805) 322-9242x Business Phone: (805) 322-9242x 24-Hour Phone : (805) 664-0879x 24-Hour Phone : (805) 836..,.1609x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact : Phone: ( ) - x MailAddr: 6001 TRUXTUN AVE 490 State: CA City : BAKERSFIELD Zip : 93309 Owner MARK A KINNSCH/AMPARO M KINNSCH Phone: ( ) - x Address : 6001D TRUXTUN. 1 SUITE 490 AVE State: CA City : BAKERSFIELD Zip : 93309 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: One Unified List 9 All Materials at Site 9 p= Hazmat Inventory p== MCP+DailyMax Order Hazmat Common Name... SpecHaz EPA Hazards NITROUS OXIDE OXYGEN CARBON DIOXIDE HELIUM F P IH G F P IH G F P IH G F P IH G ~, fiIIM-}L. Æ 14W~f,Hbo hereby csii¡~ ~h~ ! h81vS (Typs or print name) reviewed the attached hm:aro1oo~ ma~suiai~ manags- M. ¡!}?-)'-- A- \L.I t\) J'I <) L\:1t /P Ifr\ f) -, msnt plai11CìJi" 1ì~J'\ff'A1~ CI/€&tnd ~ha~ ¡~ alo~g wi~h (~IMOO) any corrsdlons ©öns~itu~~ a ~om~ls~s âìnd oorrs©ft man- ag€lmsnt plan ~(\)r my ~di¡iy. /-?1-~ i)mþ DailyMax MCP 562.00 FT3 Hi 562.00 FT3 Low 425.00 FT3 Min 40.00 FT3 Min 12/20/1999 .i:. !i e e F MARK A KINNSCH DMD DENTAL CARE p= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME NITROUS OXIDE SiteID: 215-000-000521 ì Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit SOUTH CENTER Map: Grid: CAS # STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 562.00 FT3 Daily Average 281.00 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 p= Inventory Item 0002 F= COMMON NAME / CHEMICAL NAME OXYGEN Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit SOUTH CENTER Map: Grid: CAS # 7782-44-7 STATE.- TYPE Gas Pure PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 562.00 FT3 Daily Average 281.00 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 P IH / / / Low HAZARD ASSESSMENTS -2- 12/20/1999 ·.. ,'; e e F MARK A KINNSCH DMD DENTAL CARE p= Inventory Item 0003 = COMMON NAME / CHEMICAL NAME CARBON DIOXIDE SiteID: 215-000-000521 ì Facility Unit: Fixed Containers on Site ì Days On Site 365 Location within this Facility Unit SOUTH CENTER Map: Grid: CAS # 128-38-9 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container FT3 AMOUNTS AT THIS LOCATION Daily Maximum 425.00 FT3 Daily Average 425.00 FT3 %Wt. RS CAS # 100.00 Carbon Dioxide No 124389 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min HAZARD ASSESSMENTS p= Inventory Item 0004 r= COMMON NAME / CHEMICAL NAME HELIUM Facility Unit: Fixed Containers on Site ì Days On Site Location within this Facility Unit INTERIOR GAS STORAGE ROOM Map: Grid: CAS # 7440-59-7 - TYPE Pure PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER . Largest Container 80.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 40.00 FT3 Daily Average 240.00 FT3 I tWt. I : 100.00· Helium HAZARDOUS COMPONENTS ~ CAS # I 7440597 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min HAZARD ASSESSMENTS -3- 12/20/1999 ." e e f MARK A KINNSCH DMD DENTAL CARE I f= Notif./Evacuation/Medical Agency Notification SiteID: 215-000-000521 9 Fast Format ì Overall Site 9 01/07/1990 FOLLOWING DETECTION OF LEAK OR FAILURE OF BACKUP SYSTEM THAT CAN SAFELY RESOLVED (SHUT OFF) OR EMERGENCY DETERMINED SUCH AS FIRE: TRAINED EMPLOYEE OR OWNER WILL CALL 911 AND EXPLAIN EXISTENCE OF GAS AND REQUEST ASSISTANCE. IF FACILITY PHONE IS NOT ABLE TO BE GO TO OTHER OFFICE NEARBY. NOT BE DELEGATED N20/02 USED WILL Employee Notif./Evacuation 01/07/1990 THE OWNER OR DELEGATED EMPLOYEE WILL DETERMINE EMERGENCY, AND NOTIFY ALL EMPLOYEES VIA INTERCOM OR VERBALLY AND EVACUATE THE PATIENTS FOLLOWING ESCORT. Public Notif./Evacuation 01/07/1990 ALL ROOMS CHECKED BY OWNER, OR DELEGATED EMPLOYEE, OF IMMEDIATE FACILITY; SECOND EMPLOYEE WILL ADVISE SURROUNDING OFFICES. ALL TO EVACUATE AS NECESSARY TO NORTH SIDE OF PARKING LOT. Emergency Medical Plan 01/07/1990 FOLLOWING CALL TO 911 (PARAMEDICS/AMBULANCE) INJURED PERSONS TO BE TRANSPORTED TO MERCY HOSPITAL, 2 MILES AWAY. -4- 12/20/1999 ." e e F MARK A KINNSCH DMD DENTAL CARE I p= Mitigation/Prevent/Abatemt Release Prevention SiteID: 215-000-000521 ì Fast Format 1 Overall Site -1 08/27/1992 TRAINED EMPLOYEE ESCORTS SERVICE PERSON (HOPPER) VIA REAR ENTRANCE (EAST) AND SUPERVISES REMOVAL/INSTALLATION OF TANKS, SECURED BY CHAIN IN THE 1 HOUR FIRE ROOM. ALL TANKS SHUTOFF & CAPPED WHEN TRANSPORTED. Release Containment 08/27/1992 FAIL SAFE FAN EQUIPPED WITH ALARM TO EXHAUST AND PREVENT GAS BUILD UP. Clean Up 08/27/19921 I NONE LISTED Other Resource Activation -5- - 12/20/1999 ;-;:J, .. ..¿. e e F MARK A KINNSCH DMD DENTAL CARE I f= Site Emergency Factors ~ Special Hazards Utility Shut-Offs SiteID: 215-000-000521 9 Fast Format 9 Overall Site 9 I 08/27/1992 A) GAS - NONE B) ELECTRICAL - BATHROOM C) WATER - COMPRESSOR CLOSET D) SPECIAL - NONE E) LOCK BOX - NO Fire protec./Avail. Water 08/27/1992 PRIVATE FIRE PROTECTION - CEILING SPRINKLER IN NITROUS ROOM; FIRE EXTINGUISHERS FIRE HYDRANT - 75 FEET IN FRONT OF THE NORTH SIDE OF BUILDING Building Occupancy Level -6- 12/20/1999 it,:;:. .~ -... . ",-:.. e e F MARK A KINNSCH DMD DENTAL CARE I F Training Employee Training SiteID: 215-000-000521 ì Fast Format ì Overall Site ì 08/14/1990 WE HAVE 5 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BI WEEKLY REVIEW/REHERSAL OF PROCEEDURES OUTLINED IN SECTION 6 BY OWNER FOLLOWING AN ESTIMATED 2 HOUR DEMONSTRATION/REHERSAL/QUIZ AND REVIEW WITH EACH EMPLOYEE. FIRE DEPARTMENT CONSULTATION WOULD BE REQUESTED INITIALLY AND AS AVAILABLE, INSTRUCTIONS AS LISTED IN "HAZARDOUS MATERIALS MANAGEMENT PLAN" ALSO REVIEWED. Page 2 [ I I Held for Future Use Held for Future Use -7- 12/20/1999 1. .. ~. ~ 09/27/96 Ae e MAR~INNSCH DMD DENTAL CARE 215-000-0 Overall Site with 1 Fac. Unit ~ CC ~ D W~-;::¡ 521 pi r g~ ·11"" ~f , I I ~ r 'Iqc'c I: ii ~- \/ h .)í) t· !. " f t 1 . -é/> ¡ -'--,..,~_.~-~ Location: 6001 TRUXTUN AV 490 Map:102 Haz:2 Type: 3 City . BAKERSFIELD Grid: 34A FlU: 1 AOV: 0.0 . --- Contact Name Title - Contact Name Title MARK A KINNSCH I OWNER LAINIE TORIGIANI I DENTAL ASSISTAN Business Phone: (805) 322-9242x Business Phone: (805) 322-9242x 24-Hour Phone · (805) 664-0879x 24-Hour Phone : (805) 836-1609x · Pager Phone · ( ) - x Pager Phone . ( ) - x · . Administrative Data Mail Addrs: 6001 TRUXTUN AV 490 D&B Number: City: BAKERSFIELD State: CA Zip: 93309- Comm Code: 215-011 BAKERSFIELD STATION 11 SIC Code: Owner: MARK A KINNSCH/AMPARO M KINNSCH Phone: @) ç "'$ Z:L Lf CJ!2- Address: 6001D TRUXTUN AVE., SUITE 490 State: CA City: BAKERSFIELD Zip: 93309- Summary ~ ~ {~~. - = General Information ~ki ~ T J\f tV <7 eJ.\ J~P/Vj¡V Do hereby certify that I have , , (Type or print n:am~) . d the attached hazardouS matelials manage- reviews . ~ ÇA0{~ and that it along with ment plan for (N3rr.ao¡Bu~inaSS) I ~ nd correct man.. any corrections constitute a comp eLe a agement plan for my faci\ity. ~ cIl2../{);ß1(; { .. 'i\. 09/27/96 ~ e MARK~ KINNSCH DMD DENTAL CARE 215-000-000521 Hazmat Inventory List in MCP Order Page 2 02 - Fixed Containers on Site PIn-Ref Name/Hazards Form Max Qty MCP 02-001 NITROUS OXIDE Gas 562 High þ> Fire, Pressure, Immed Hlth FT3 02-002 OXYGEN Gas 562 Low þ> Fire, Pressure, Immed Hlth FT3 02-003 CARBON DIOXIDE Gas 425 Minimal þ> Fire, Pressure, Immed Hlth FT3 H-£L1UM ~S ? (.eSSLtf~ fA ~ fr IN fJÂ-Tl ON 1,r -f. 09/27/96 Auft e MARK~KINNSCH DMD DENTAL CARE 215-000-000521 02 - Fixed Containers on Site Page 3 Hazmat Inventory Detail in MCP Order 02-001 NITROUS OXIDE ~ Fire, Pressure, Immed Hlth Gas 562 High FT3 CAS #: Trade Secret: No Form: Gas Type: Pure Days: 365 Use: ANESTHETIC Daily Max FT3 ----r-- Daily Average FT3 --r-- Annual Amount FT3 -- 562 I 281.00 I 1,686.00 Storage r Press T Temp ~ PORT. PRESS. CYLINDER Above AmbientSOUTH CENTER Location - Cone l 100.0% Nitrous Oxide Components r: MCP ----rGuide IHigh I 14 02-002 OXYGEN ~ Fire, Pressure, Immed Hlth Gas 562 Low FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: ANESTHETIC Daily Max FT3 ----r-- Daily Average FT3 --r-- Annual Amount FT3 -- 562 I 281.00 I 1,686.00 Storage r Press T Temp -:-, PORT. PRESS. CYLINDER Above Ambient/SOUTH CENTER Location - Cone -I Components ~ MCP iUide 100.0% Oxygen, Compressed Low 14 02-003 CARBON DIOXIDE Gas 425 Minimal ~ Fire, Pressure, Immed Hlth FT3 CAS #: 128-38-9 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: AEROSOL/INFLATION Daily Max FT3 ----r-- Daily Average FT3 --r-- Annual Amount FT3 -- 425 / 425.00 I 2,550.00 Storage r Press T Temp ~ PORT. PRESS. CYLINDER Above AmbientSOUTH CENTER Location - Cone -I 100.0% Carbon Dioxide Components r:- MCP ----rGuide I Low I 21 ~ . ~. 09/27/96 ~e e MARK ~ KINNSCH DMD DENTAL CARE 215-000-000521 00 - Overall Site Page 4 <D> Notif./Evacuation/Medical <1> Agency Notification FOLLOWING DETECTION OF LEAK OR FAILURE OF BACKUP SYSTEM THAT CAN NOT BE SAFELY RESOLVED (SHUT OFF) OR EMERGENCY DETERMINED SUCH AS FIRE: DELEGATED TRAINED EMPLOYEE OR OWNER WILL CALL 911 AND EXPLAIN EXISTENCE OF N20/02 GAS AND REQUEST ASSISTANCE. IF FACILITY PHONE IS NOT ABLE TO BE USED WILL GO TO OTHER OFFICE NEARBY. <2> Employee Notif./Evacuation THE OWNER OR DELEGATED EMPLOYEE WILL DETERMINE EMERGENCY, AND NOTIFY ALL EMPLOYEES VIA INTERCOM OR VERBALLY AND EVACUATE THE PATIENTS FOLLOWING ESCORT. <3> Public Notif./Evacuation ALL ROOMS CHECKED BY OWNER, OR DELEGATED EMPLOYEE, OF IMMEDIATE FACILITY; SECOND EMPLOYEE WILL ADVISE SURROUNDING OFFICES. ALL TO EVACUATE AS NECESSARY TO NORTH SIDE OF PARKING LOT. <4> Emergency Medical Plan FOLLOWING CALL TO 911 (PARAMEDICS/AMBULANCE) INJURED PERSONS TO BE TRANSPORTED TO MERCY HOSPITAL, 2 MILES AWAY. 'i ~ . ." 09/27/96 kre e MARK'f{ KINNSCH DMD DENTAL CARE 215-000-000521 00 - Overall Site Page 5 <E> Mitigation/Prevent/Abatemt <1> Release Prevention TRAINED EMPLOYEE ESCORTS SERVICE PERSON (HOPPER) VIA REAR ENTRANCE (EAST) AND SUPERVISES REMOVAL/INSTALLATION OF TANKS, SECURED BY CHAIN IN THE 1 HOUR FIRE ROOM. ALL TANKS SHUTOFF & CAPPED WHEN TRANSPORTED. <2> Release Containment FAIL SAFE FAN EQUIPPED WITH ALARM TO EXHAUST AND PREVENT GAS BUILD UP. <3> Clean Up NONE LISTED <4> Other Resource Activation .... <'.: \, ,i ...:; kre e MARKtt KINNSCH DMD DENTAL CARE 215-000-000521 00 - Overall Site Page 6 09/27/96 <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - BATHROOM C) WATER - COMPRESSOR CLOSET D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - CEILING SPRINKLER IN NITROUS ROOM; FIRE EXTINGUISHERS FIRE HYDRANT - 75 FEET IN FRONT OF THE NORTH SIDE OF BUILDING <4> Building Occupancy Level ,-f'" .c ~ ¡:.,.-; e MARK~~INNSCH DMD DENTAL CARE 00 - Overall Site '. 09/27/96 215-000-000521 Page 7 <G> Training <1> Employee Training WE HAVE 5 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BI WEEKLY REVIEW/REHERSAL OF PROCEEDURES OUTLINED IN SECTION 6 BY OWNER FOLLOWING AN ESTIMATED 2 HOUR DEMONSTRATION/REHERSAL/QUIZ AND REVIEW WITH EACH EMPLOYEE. FIRE DEPARTMENT CONSULTATION WOULD BE REQUESTED INITIALLY AND AS AVAILABLE, INSTRUCTIONS AS LISTED IN "HAZARDOUS MATERIALS MANAGEMENT PLAN" ALSO REVIEWED. <2> Page 2 <3> Held for Future Use <4> Held for Future Use '" ç.;.i;1\- .~.:, HAZ.DOUS MATERIALS INVE.RY M~'<' Ij-( (lNNSlttr¡V¡/I;¡ .þJ . l>-e'^1ai Œ-Oirtl)? Address - Þ (/IrK ¡J~, Pagelofl :Jsiness Name CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [~ddition [ ] Revision [ ) Deletion [ ] Check if chemical is a NON TRADE SECRET [J TRADE SECRET [ I 2) Common Name: Chemical Name: 3) DOT # (optional) AHM ( ! CAS # 4) PHYSICAL & HEALTH HAZARD CATEGORIES HEAL ]:I- Immediate Health (Acute) [v(" Delayed Health (Chronic) 5) WASTE CLASSIFICATION 6) PHYSICAL STATE Solid [J liquid (J Gas (~ USE CODE Pure [~ixture [J Waste [J Radioactive [ æfQl:. ALl. n;,U APPlY 7) AMOUNT AND TIME AT FACIUTY Maximum Daily Amount: Average Daily Amount: .Annuðl Aiiiûunt: largest Size Container: # Days On Site UNITS OF MEASURE ./ Ibs [ J gaJ [) 1t3 [V'f curies [ ] 8) STORAGE CODES a) Container. b) Pressure: c) Temperature: oq '7- If Circle Which Months: M, A, M, J, J, A, S, 0, N, D 9) MIXTURE: list the tnree most hazardous cnemlcal components or at1y AHM components 1) leJ ' COMPONENT ~ ( ¡)(\I\ . 3\ 10) Location f)J 1171 (/If $ '.(? r " ,ft 'C-cd I //1/ / r;,~§,J/rj _ 7 % wr ÎJ7 AHM _t..:-rX/d. ':;;¿"2 _ J {'jO - (0 [ ] [ ] [ J f;(f ¡¿oor , ¡I 2) CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ J Revision ( ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ TRADE SECRET [ ] 2) Common Name: 3) DOT # (optionaJ) ChemicaJ Name: AHM ( ] CAS # 4) PHYSICAL & HEALTH HAZARD CATEGORIES PHYSICAL Fire [] Reactive [J Sudden Release of Pressure [ ] HEALTH Immediate Health (Acute) [! Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [J liquid (J Gas [ ] Pure [] Mixture [J Waste [) Radioactive [ J OŒCJ(~.L THAT Am. Y 7) AMOUNT AND TIME AT FACIUTY Maximum Daily Amount: Average Daily Amount: Annual Amount: Largest Size Container: # Days On Site UNITS OF MEASURE Ibs [ ] gaJ [] 1t3 [ ] curies [ ] 8) STORAGE CODES a) Container: b) Pressure: c) Temperature: Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, 0, N, D 9) MIXTURE: list the three most hazardous chemical components or at1y AHM components COMPONENT CAS # %wr AHM [ ] [ ] [ ] 1) 2) 3) epresentative ~rI,1U-1!- ---v~ (()--/'D-9b Ignature Data o..-3Q 1S11id REœOI V LEPC ØTMQIIIfIIO RJIItI BAKERS~LD CITY FIRE DEPAj¡TMENT HAZAWbous MATERIALS INVEN"1WRV ;:1:. ;.', Page_of_ 3usiness Name Address CHEMICAL DESCRIPTION ') INVENTORY STATUS: New [ ] Addition [ J Revision [ ) Deletion [ ) Check if chemicaJ is a NON TRADE SECRET ( ) TRADE SECRET ( ) 2) Common Name: 3) DOT # (optional) ChemicaJ Name: AHM [ ) CAS # \ 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ J Reactive [ ) Sudden Release of Pressure [ J Immediate Health (Acute) [ ) Delayed Health (Chronic) ( ] , I 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE I 6) PHYSICAL STATE Solid [ J Uquid [ ) Gas ( ] Pure [ ] Mixture [ ) Waste [ ] Radioactive [ ] CHfc:.xAil mAT A.M.Y I I 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: 100 [ ] gal [ ] ft3 [ ] a) Container: I Average Daily Amount: - ---- - - - -- - - - cunes [ ] b) Pressure: I Annual Amount: c) Temperature: Largest Size·Container: I # Days On Site Circle Which Months: All Year. J, F. M, A, M, J, J, A, S. 0, N, D 9) MIXTURE: Ust COMPONENT CAS # %WT AHM the three most hazardous 1 ) [ ] cnemlcaJ components or any AHM components 2) [ ] 3) [ ] , 10) Location I CHEMICAL DESCRIPTION I I I 1) INVENTORY STATUS: I New [ ] Addition [ ] Revision [ ] Deletion [ J Check if chemica! is a NON TRADE SECRET [ ] TRADE SECRET [ ] il 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS# :1 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ I Immediate Health (Acute) [ J Delayed Health (Chronic) [ ] ,I 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 'j 6) PHYSICAL STATE ~Solid [-J t.iquid [ ] Gas [ ] - - -- ·pûre ¡-] ~iXlure [ ] Wasiê n Radioactive - [ ] :1 CHfCX AJ...L TH,U APPl '( ! 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES ! Maximum Daily Amount: Ibs [ ] gal [ ] ft3 [ ] a) Container: Average Daily Amount: cunes [ ] b) Pressure: . Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year, J. F. M. A. M, J. J, A, S, 0, N, D 9) MIXTURE: Ust COMPONENT CAS # %WT AHM the three most hazardous 1) [ ] chemica! components or any AHM components 2) [ ] 3) [ ] 1 0) Location. / certHy unaer penalty or law, that I have personally examined and am familIar WIth the mtomaoon submItted on this and all attached documents. I believe the submitted information is true. accurate, and complete. PRINT Name & Title of Authorized Company Representative Signature Date "'..."..30. 11112 ~" LEPC STofrMWI:J FCR" ~ -¡& ;¡. - e ;- ~ 08/05/92 MARK V KINNSCH DMD DENTAL CARE 215-000-000521 Overall Site with 1 Fac. Unit Page 1 General Information Location: 6001 TRUXTUN AV 490 Map: 102 Hazard: Low Community: BAKERSFIELD STATION 11 Grid: 34A FlU: 1 AOV: 0.0 - Contact Name Title Business Phone - 24-Hour Phone MARK A KINNSCH OWNER (805) 322-9242 x (805) 664-1445 CINDI flARBIN DENTAL ASSISTANT (805) 322-9242 x (805) 393-8066 Administrative Data Mail Addrs: 6001-490 TRUXTUN AV D&B Number: City: BAKERSFIELD State: CA Zip: 93309- Comm Code: 215-011 BAKERSFIELD STATION 11 SIC Code: Owner: MARK A KINNSCH/AMPARO M KINNSCH Phone: ( ) - Address: 6001D TRUXTUN AVE., SUITE 490 State: CA City: BAKERSFIELD Zip: 93309- Summary REce'VED . ~ij~ 2 ·6:·%9~2 HAZ. M~ 1, 1m \f. ~g MM-I¿ fj. I JLrN/lfS&J.- [Q)© ~®fi'®f9Jv ~v=\W~ ~~~ ~ ~®v® ~ fi®1(J~®W®©J ~Û'i!® ®~~©~"cg tI&!ZtalldoßJ!~ mSì~®rrå®~~ m~ú1®@®o þl M-\L- Y7 I ¡¿/;VIIJsQ,tf m~ú1~ íQ)~@ìú1 ~@rr1>J;NJ14.L ~®ú1rõ1 ~Û'i!®~ !Q a!©ú'I@ w!~h (~Q of SwirwOO) ~v ::::::7:::~~:~mp,~® andcorred m_ ~v; ~ t;"· ~~~--UJf7¿ cØ\ ~t, ro ~ / U Sf.'- A-~ DLAfl--INE f Hl4-bfJ,,¡6rnrfb iN (ill \2-~Vt >1 DAJ <; 10 OJ(þ ¡.AJ ~E t> J ~ ;Jf .? ~.. '1 ?' e e .' 08/05/92 MARK V KINNSCH DMD DENTAL CARE 215-000-000521 02 - Fixed Containers on Site Page 2 Hazmat Inventory Detail in Reference Number Order 02-001 NITROUS OXIDE ~ Fire, Pressure, Immed H1th Gas 562 High FT3 CAS #: Trade Secret: No Form: Gas Type: Pure Days: 365 Use: ANESTHETIC Daily Max FT3 ----r-- Daily Average FT3 ~ Annual Amount FT3 -- 562 I 281.00 I 1,686.00 Storage r Press T Temp ~ PORT. PRESS. CYLINDER Above Ambient I SOUTH CENTER Location - Cone l 100.0% Nitrous Oxide Components ~ MCP ---rList High I 02-002 OXYGEN ~ Fire, Pressure, Immed Hlth Gas 562 Low FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: ANESTHETIC Daily Max FT3 ----r-- Daily Average FT3 ~ Annual Amount FT3 -- 562 I 281.00 I 1,686.00 Storage r Press T Temp ~ PORT. PRESS. CYLINDER Above Ambient I SOUTH CENTER Location .,... Cone l 100.0% Oxygen, Compressed Components I~ MCP ---rList Low I 02-003 CARBON DIOXIDE ~ Fire, Pressure, Immed Hlth Gas 425 Minimal FT3 CAS #: 128-38-9 Trade Secret: No Form: Gas Type: Pure Days: 365. Use: ANESTHETIC Daily Max FT3 ----r-- Daily Average FT3 ~ Annual Amount FT3 -- 425 I 425.00 I 2,550.00 Storage r Press T Temp ~ PORT. PRESS. CYLINDER Above Ambient I SOUTH CENTER Location - Cone -/ 100.0% Carbon Dioxide 'Components r; MCP :-rList Minimal I ~ .' ~ e e 08/05/92 MARK V KINNSCH DMD DENTAL CARE 215-000-000521 00 - Overall Site Page 3 <D> Notif./Evacuation/Medical. <1> Agency Notification FOLLOWING DETECTION OF LEAK OR FAILURE OF BACKUP SYSTEM THAT CAN NOT BE SAFELY RESOLVED (SHUT OFF) OR EMERGENCY DETERMINED SUCH AS FIRE: DELEGATED TRAINED EMPLOYEE OR OWNER WILL CALL 911 AND EXPLAIN EXISTENCE OF N20/02 GAS AND REQUEST ASSISTANCE. IF FACILITY PHONE IS NOT ABLE TO BE USED WILL GO TO OTHER OFFICE NEARBY. <2> Employee Notif./Evacuation THE OWNER OR DELEGATED EMPLOYEE WILL DETERMINE EMERGENCY, AND NOTIFY ALL EMPLOYEES VIA INTERCOM OR VERBALLY AND EVACUATE THE PATIENTS FOLLOWING ESCORT. <3> Public Notif./~vacuation ALL ROOMS CHECKED BY OWNER, OR DELEGATED EMPLOYEE, OF IMMEDIATE FACILITY; SECOND EMPLOYEE WILL ADVISE SURROUNDING OFFICES. ALL TO EVACUATE AS NECESSARY TO NORTH SIDE OF PARKING LOT. <4> Emergency Medical Plan FOLLOWING CALL TO 911 (PARAMEDICS/AMBULANCE) INJURED PERSONS TO BE TRANSPORTED TO MERCY HOSPITAL, 2 MILES AWAY. ..'; .j$f' if, ;;:. e e 08/05/92 MARK V KINNSCH DMD DENTAL CARE 215-000-000521 00 - Overall Site Page 4 "<E> Mitigation/Prevent/Abatemt <1> Release Prevention TRAINED EMPLOYEE ESCORTS SERVICE PERSON (HOPPER) VIA REAR ENTRANCE (EAST) AND SUPERVISES REMOVAL/INSTALLATION OF TANKS, SECURED BY CHAIN IN THE 1 HOUR FIRE ROOM. ALL TANKS SJUTOFF & CAPPED WHEN TRANSPORTED. S~ <2> Release Containment FAIL SAFE FAN EQUIPPED WITH ALARM TO EXHAUST AND PREVENT GAS BUILD UP. <3> Clean Up NONE LISTED <4> Other Resource Activation ~'. ..,Ji" .!; ~ . e e 08/05/92 MARK V KINNSCH DMD DENTAL CARE 215-000-000521 00 - Overall Site Page 5 <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - BATHROOM C) WATER - COMPRESSOR CLOSET D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avai1. Water PRIVATE FIRE PROTECTION - CEILING EXTINGUISHERS SPRINKLE~ NITROUS ROOM; FIRE FIRE HYDRANT - 75 FEET IN FRONT OF THE NORTH SIDE OF BUILDING <4> Building Occupancy Level . -ti .{,.¡.. ~.: e e 08/05/92 MARK V KINNSCH DMD DENTAL CARE 215-000-000521 00 - Overall Site Page 6 <G> Training <1> Page 1 WE HAVE 5 EMPLOYEES AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE BI WEEKLY REVIEW/REHERSAL OF PROCEEDURES OUTLINED IN SECTION 6 BY OWNER FOLLOWING AN ESTIMATED 2 HOUR DEMONSTRATION/REHERSAL/QUIZ AND- REVIEW WITH EACH EMPLOYEE. FIRE DEPARTMENT CONSULTATION WOULD BE REQUESTED INITIALLY AND AS AVAILABLE, INSTRUCTIONS AS LISTED IN "HAZARDOUS MATERIALS MANAGEMENT PLAN" ALSO REVIEWED. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use .------ -. .¡ ¡: e e t' 08/05/92 MARK V KINNSCH DMD DENTAL CARE 215-000-000521 Overall Site with 1 Fac. Unit Page 1 General Information Location: 6001 TRUXTUN AV 490 Community: BAKERSFIELD STATION 11 Map: 102 Hazard: Low Grid: 34A FlU: 1 AOV: 0.0 Contact Name MARK A KINNSCH Title Business Phone (805) 322-9242 x OWNER Administrative Data Mail Addrs: 6001-490 TRUXTUN AV City: BAKERSFIELD Comm Code: 215-011 BAKERSFIELD STATION 11 D&B Number: State: CA Zip: 93309- SIC Code: Owner: MARK A KINNSCH/AMPARO M KINNSCH Address: 6001D TRUXTUN AVE., SUITE 490 City: BAKERSFIELD Phone : (Ø~ê>~22 - 1')1/ State: CA Zip: 93309- Summary I, Do hereby certffy that I have (Type or print name) reviewed the attached hazardous materials manage- ment plan for and that it along with (Name 01 8usiness) any corrections constitute a complete and correct man- agement plan for my facility. M ~(J)fl o;JS , 0l80'7)(çbq-f.)g7~ @ T/NIt ElL{ Or) lìCN714l-.4)ç >TI4-Nf. «'6£><7) 3t2iVil. (f1¡)~3 (iJ - 51 ~5 I ) ~~} - I q ~5 ~~:t$~'¡:; i'.'. r SlgnaIUI8 Date '" ,- e - þ 08/05/92 MARK V KINNSCH DMD DENTAL CARE 215-000-000521 02 - Fixed Containers on Site Page 2 Hazmat Inventory Detail in Reference Number Order 02-001 NITROUS OXIDE ~ Fire, Pressure, Immed Hlth Gas 562 High FT3 CAS =It: Trade Secret: No Form: Gas Type: Pure Days: 365 Use: ANESTHETIC Daily Max FT3 ----r-- Daily Average FT3 ~ Annual Amount FT3 -- 562 I 281.00 I 1,686.00 Storage r Press T Temp ~ PORT. PRESS. CYLINDER Above AmbientSOUTH CENTER Location - Cone -, 100.0% Nitrous Oxide Components ~ MCP ---rList High I 02-002 OXYGEN ~ Fire, Pressure, Immed Hlth Gas 562 . Low FT3 CAS =It: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: ANESTHETIC Daily Max FT3 ----r-- Daily Average FT3 ~ Annual Amount FT3 -- 562 281.00 1,686.00 Storage r Press T Temp ~ PORT. PRESS. CYLINDER Above AmbientSOUTH CENTER Location .,.... Cone l 100.0% Oxygen, Compressed Components r=- MCP ---rList ¡Low I 02-003 CARBON DIOXIDE ~ Fire, Pressure, Immed Hlth Gas 425 Minimal FT3 CAS =It: 128-38-9 Trade Secret: No Form: Gas Type: Pure Days: 365, Use:--ANESTUF;.rpTC-~@ Daily Average FT3 ~ Annual Amount FT3 -- 425.00 2,550.00 Daily Max FT3 ----r-- 425 Storage r Press T Temp ~ PORT. PRESS. CYLINDER Above AmbientSOUTH CENTER Location - Cone -, 100.0% Carbon Dioxide Components r; MCP :-rList Minimal I ~ "Þf~Mr~~c; t ()¡J '\1)R~~mll Fo{?MÞf.. f;<!~) ;' < . ','"j e, _ MARK V KINNSCH DMD DENTAL CARE 215-000-000521 00 - Overall Site Page 4 08/05/92 <E> Mitigation/Prevent/Abatemt <1> Release Prevention TRAINED EMPLOYEE ESCORTS SERVICE PERSON (HOPPER) VIA REAR ENTRANCE (EAST) AND SUPERVISES REMOVAL/INSTALLATION OF TANKS, SECURED BY CHAIN IN THE 1 HOUR FIRE ROOM. ALL TANKS SJUTOFF & CAPPED WHEN TRANSPORTED. 5HlAíOW <2> Release Containment FAIL SAFE FAN EQUIPPED WITH ALARM TO EXHAUST AND PREVENT GAS BUILD UP. <3> Clean Up NONE LISTED <4> Other Resource Activation ,Ý / ",/. ,I,. ,/~,:¡, ... ~ e e MARK V KINNSCH ,DMD DENTAL CARE 215-000-000521 00 - Overall Site 08/05/92 j, <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - BATHROOM C) WATER - COMPRESSOR CLOSET D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION EXTINGUISHERS - CEILING SPRINKLER)( IN NITROUS ROOM; FIRE ~rf-IN¡LLfft ~ LON") FIRE HYDRANT - 75 FEET IN FRONT OF THE NORTH SIDE OF BUILDING <4> Building Occupancy Level , Page 5 RECEIVED CITY of BAKERSFIELD AUG 2 0 1990 HAZARDOUS MATERIALS INVENTORY Farm and Agticu1ture [] Standard Business 1Ek NON-TRADE SECRETS HAZ. MAT. 01\/.a92 USINESS NAME: }~RK KINNSC~ DENT~1 ~ßRE- OWNER NAME: MARK A. KINNSCH D.M.D. NAME OF THIS FACILITY: ~ERr.Y MEDTr.AT OCATION: 60Ul D -Su1te 9U 'Lüx ~ ADDRESSbOOl1J=-s~~ H£-JRB~T~~ è¥ENTTE STANDARD IND. CLASS CODE: l1Y ZIP: 91109 . CITY ZIP:£AKE--F--~D::::-::::_ ::::::::3::::::: DUN AND BRADSTREET NUMBER--- ----.- HONÈ II: (R05) 1')? 9?l1? PHONÈ II:JB1JSS32L9..24..2_ _ _ _ _ REFER T~~ ~TTDN~ ~UH ~RDPER CODES --- ----- ------ 1 2 3 6 7 8 9 10 11 12 Trans TYDe ~ax Measure I Dys Cont Cont Cont Use Loc~tion Wher~ Code Cooe Allt UnIts on SIte lype Press TeinD Code Stored In FaCIlIty N _ 1 P_=, ' PhY~ic~1 ,nd Health Hazard (C ec a I that acplY¡ NITROUS of 'PARK 13 , bv lit' 1A ~a~es of ~ixture/Ç:~~o~ents See Instr~:t1cns D Reactivity FT3 C.A.S. HUi!\ber OXIDE (NZO) D Oe 1 ayed ŒI Sudd~n Re I ease Health of Pressure SOUTH CENTER Name & C.A.S. Number 9~ H:::-,eo U ß v::J D.e Hazard Comoonent i2 Name & C.A.S. Number D Immediate ' Health Component 13 Name I C.A.S. Number 365~ 041z 1 41041 SOUTH CENTER Component 11 Name & C.A.S. Number I~L OX~ QQ AI ~ D D Reactivity [] SUddfn Re1ease [] Component 12 Name & C.A.S. Number Fire Hazard Immediate o Pressure Hea!th Component 13 Name I C.A.S. Number , - N P 4 04 SOUTH CENTER Phtsical ,nd Health Hajard Component 11 Name I C.A.S. Number ( he~k a I that apply COZ Component 12 Name & C.A.S. Number D Fire Hazard [] Reactivity [] Oe hyed [] suddf" Re lease [] Immediate Health o Pressure Health Component 13 Name I C.A.S. Number Physical ,nd Health Ha~ard (Check all that apply) C.A.S. Number Cc~pcnent 11 Na:.e & C.Â.S. Hur.ber [] Fire Hazard [] Reactivity [] Delayed [] Sudd~n Release Health of Pressure Component 12 Name & C.A.S. Humber D Immediate Health Component 13 Name & C.A.S. Number EMERGENCY CONTACTS # '!MARK A KTNN~r.H. Dt.TNFR 664 IM5- ~2 _~ARO KI1ïNSCH OfFICE MANA(;ER lialle Tme 2T""RTl'!ione Rai:1e . T1 Iè ertification' (Re~d and sign af1er comp7eting a77 sections)' . . I certIfy under penalìï 0 law that I havè persona Iy examln~~ ond om familla~ with the informatIon sUQmitteó in this ond ,all ~. . 't..tached doc~ments, anQ t at based on my InQuIry 0 those InOlvlduals res.p.onslble. for obtaln1ng the I..n. formatIon.. 1 belIeve that th~~ ·ubmltted InformatIon IS true, accurate, and cor-plete. GJ¡.4 . MARK A. KINNSCH. D.H.D.·· .~ 8-17-90 .!i\e ~rd ot Ical -tItle 01 c~n~rJocerHor UR o~n2rJooer8tor S autnorlzeö reoresentatlve . . n ure UH~iqr.=a 1?ft¡h1ï~ e ~@~. Bakersfield Fire d'rpt. Hazardous Materials Inspection Date Completed ß· 7 . ?O / Business Name: ~ ~.1J\(\/V\hr~ VY\ 0 ~ T~ Â~ *L\QO Location: ~{)O \ ~ E r ~ nl E D AU6 1 0 j9~@ Anß~'H" .~ N.",., Plan ID # 215-000~ (Top right comer Business Plan) ~ Station No. l1 Shift L. Inspector 7. w~ J S, p~ Adequate Inadequate D ~ D 5ZJ ~ D [).(1 D Verification of Inventory Materials ~ k>L /fiI).J. ~ pw-e- I' r/ Verification of Quantities O~erification of Location Proper Segregation of Material Comments: D Verification ofMSDS Availability ~ Number of Employees 5 Verification of Haz Mat Training ~ Comments: D Verification of Abatement Supplies & Procedures ~ Comments: D Emergency Procedures Posted D ® Containers Properly Labeled Comments: ~ D Verification of Facility Diagram ~ Special Hazards Associated with this Facility: D Violations: ~~ ~~ ~ ~ 0wJ) tWD ~ DA<".A?,~~ ~. ö ~~ 1- CD Z "'" ~, FD 1652 (Rev, 3-89) White-Haz Mat Div, Yellow-Station Copy Pink-Business Office I '" :~,. ¡.~~ l ,SU.. ..~ :,-, '.1.',,": '-~"\ '.. ""-;:-' ,IJ~"'·' ~þ'..i)~. -'('''''':/>''''1,. ~,; ....:;: e .......; ,;. ". ~'f"'¡-·;:r-iõ.,T-,¡;'~~-.~~'" r-~.:~..- _4~ ·v; '''i....íí -:;~ ",.-.,'ir:..-r" 1r.. .:_ '-~ :.. J ," '-,.: : . i· "~: e uu( c~ --~ -qD ot4Y ~ . e Bakersfield Fire Dept. Hazardous Materials Division ~ ~ 2- 2130 "G" Street - () Bakersfield, CA. 93301 ~.QS2 Gr ¿ ~5~{ INSTRUCTIONS: HAZARDOUS MATERIALS MANAGEMENT PLAN IOd- - 3Y f\ 1\ lIe 1. 2. 3, 4. To avoid further action, return this form within 30 days of receipt. TYPE/PRINT ANSWERS IN ENGLISH. Answer the questions below for the business as a whole. Be brief and concise as possible. ~(ECIE~VfE¡g ..'N) ~ 2 1990 HAZ. MAT. DIV. SECTION 1: BUSINESS IDENTIFICATION DATA BUSINESS NAME: MARK A. KINNSCH, D.M.D. DENTAL CARE LOCATION: MERCY MEDICAL PARK MAILING ADDRESS: 600lD. TRUXTUN AVE SUITE 490 CITY: BAKERSFIELD , STATE: SÅ- ZIP: 93309 PHONE: (805) 322 9242 DUN & BRADSTREET NUMBER: SIC CODE: PRIMARY ACTIVITY: GENERAL DENTISTRY OWNER: MARK A. KINNSCH, D.M.D. AMPARO M. KINNSCH MAILING ADDRESS: SAME SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE 1 . MARK A hJ:J:ilN$.(;;;H):" D. M . D . / OWNER (805) 322 9242 664 1445 2. CINDI HARBIN, DENTAL ASSISTANT (805) 322 9242 393 8066 1. FOI ~., Bakersfield Fire Dept. e e Hazardous Materials Division / -. HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMBER OF EMPLOYESS: 3 MATERIAL SAFETY DATA SHEETS ON FILE: \E-S BRIEF,SUMMARY OF TRAINING PROGRAM: BY WEEKLY REVIEW / REHEARSAL OF PROCEEDURES OUTLINED IN SECTION.6" ,BY OWNER FOLLOWING AND ESTIMATED 2.H.R.;..pE}10NS.TRK';t.r:O~/REHEARSAL/QUIZ AND REVIEW WITH EACH EMPLOYEE. FIRE DEPARTMENT CONSULTATION WOULD BE REQUESTED INITIALLY AND AS ~~.'{~tLAß.~~i" INSTRUCTIONS AS LISTED IN "HAZARDOUS MATERIALS MANAGEMENT PLAN': ALSO REVIEWED. ":,,1'; ,'..; I. ,.' , ~. .;J'..~ .~<:. ~{ SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: CERTIFICATION: I, ~lL 4( 'l-fNNW/7)/l-t\;) CERTIFYTHATTHEABOVEINFOR- MATlON 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. /f!W~(1L~~~ I Oi~ SIGNATURE I TITLE . 12---11~ DATE 2. FDI590 ,/' Bakersfield Fire Dept. e Hazardous Materials Divisi~ HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: TRAINED EMPLOYEE ESCORTS SERVICE PERSONE' . (HOPPER) VIA REAR ENTRANCE (EAST) AND SUPERVISES REMOVAL/INSTALLATION OF TANKS, SECURED BY CHAIN IN THE 1 HOUR FIRE ROOM. ALL TANKS SHOUTOFF & CAPPED WHEN TRANSPORTED. B. RELEASE CONTAINMENT AND/OR MINIMIZATION: FAIL SAFE FAN EQUIPED WITH ALARM TO EXHAUST AND PREVENT GAS BUILD UP. C. CLEAN-UP PROCEDURES: N/A SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): NATURAL GAS/PROPANE: N/A ELECTRICAL: BATHROOM VVATER: COMPRESSOR CLOSET SPECIAL: N/ A LOCK BOX: YE@ IF YES, LOCATION: SECTION 9: PRIV ATE FIRE PROTECTION/WATER A V AILABILlTY: A. PRIV A TE FIRE PROTECTION: CEILING SPRINKLERS IN NITROUS ROOM FIRE EXTINGUISHERS B. VVATERAVAllABILlTY (FIRE HYDRANT): 75' IN FRONT OF THE NORTH SIDE OF BUILDING. - - . - 4. FDI Bakersfield Fire Dept. e Hazardous Materials Division e HAZARDOUS MATERIALS MANAGEMENT PLAN Facility Unit Name: 6001 D. SUITE 490 SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. AGENCY NOTIFICATION PROCEDURES: FOLLOWING DETECTION OF LEA~ OR FAILURE OF BACKUP SYSTEM THAT CAN NOT BE SAFELY RESOLVED (SHUT OFF) OR EMERGENCY DETERMINED SUCH AS FIRE: DELEGATED TRAINED EM~ PLOYEE OR OWNER WILL CALL 911 AND EXPLAIN EXISTENCE OF N20 / 02 GAS AND REQUEST ASSISTANCE. IF FACILITY PHONE IS NOT ABLE TO BE USED WILL GO TO OTHER OFFICE NEARBY. B. EMPLOYEE NOTIFICATION AND EVACUATION: THE OWNER OR DELEGATED EMPLOYEE WILL DETERMINE EMERGENCY, AND NOTIFY ALL EMPLOYEES VIA ENTERCOM OR VERBALLY AND EVACUATE WITH PATIENTS FOLLOWING ESCORT. C. PUBLIC EVACUATION: ALL ROOMS CHECKED BY OWNER, OR DELEGATED EMPLOYEE, OF IMMEDIATE FACILITY; SECOND EMPLOYEE WILL ADVISE SURROUNDING OFFICES. ALL TO EVACUATE AS NECESSARY TO NORTH SIDE OF PARKING LOT. D. EMERGENCY MEDICAL PLAN: FOLLOWING CALL TO 911 (PARAMEDICS/AMBULANCE) INJURED PERSONS TO BE TRANSPORTED TO MERCY HOSPITAL, 2 MILES AWAY. 3. FOl~ CITY of BAKERSFIELD ~THAZARDOUS MATERIALS INVENTORY Farm and Agticulture __ 0 Standard Business .f.A NON-TRADE SECRETS Page of BUSINESS NAME: MARK KINNSC~~ DENTAL CARL OWNER NAME: MARK A. KINNSCHê D.M.D. NAME OF THIS FACILITY: t-jERr.y MEDTr.AT, PARK LOCATION: 60U1 U -Suite U TR1JXTU~ ADDRESSbOOlD':"S~~ ~~0-7RHíT ~ ê~ENTTK STANDARD IND. CLASS CODE: CITY ZIP: 93309 - CITY ZIP:1OOŒ:::-F--r:;D=-=- =3==----- DUN AND BRADSTREET NU/·IBER------------- PHONÈ ,,: (RO,)) 377 9742 -- rft~M~ ".¡cPP;fsiM3ccPitlrvs rUH ¡..;ROPER CODES - - - - I 2 3 . 5 5 7 8 9 0 1 21 J 11 Tr~ns TYQe Max Average Annual Measure I Dys Cant Cant Cont Use loc~tion Where r by nues of "ixture{ç~:!Iconents Code Code Allt Amt Est UnIts on SIte Type Press Temp Code Stored In Facl J Ity 'iit See lnstruc 10ns SOUTH CENTER Component 11 Name & C,A.S. Number 9 N P -- ~~ ß I Pht~iCfl ,nd ~ealth Ha~ard ( ec a I t at apply) NITROUS OXIDE (N20) o Fire Hazard 0 Reactivity 0 Delared Œl Sudd~n Release e Hea th of Pressure N P 5 Physical ~Od Health Hafard (Check a II that app I y OXYGEN o Fire Hazard 0 Reactivity Component 12 Name I C.A.S. Number o Immediate Health Component 13 Name & C.A.S. Number C.A.S. Humber (02) o De Jared 0 Sudd~n Re I ease Hea th of Pressure Name & C.A.S. Number O Component.2 Name & C.A.S. Number Immediate Health Component 83 Name & C.A.S. Number Physical ~nd Health Hafard (Check all that apply C.A.S. Number Component .1 Name & C.A.S. Number 0 Component .2 Name & C.A.S. Number Immediate Health Component 13 Name & C.A.S. NUllber Component .1 Name I C.A.S. Nu~ber 0 Component .2 Name & C.A.S. Number Immediate Health Component 13 Name & C.A.S. Number o Fire Hazard o Reactivity o Delayed 0 Sudd~n Release Health of Pressure EMERGENCY CONTACTS "1fM¡RK A. KTNNsr.H, lie Tgf~ICE MANA(~ER II f I fifi4 _1M') I Zflìfl"ñ~ [ Phrsical ~nd Health Halsrd (Check all that apply, C.A,S. Number o Fire Hazard o Reactivity o De 1 ayed 0 Sudd~n Re 1 ease Health of Pressure fJ--?l~ ~'írr¡iW--1 , ~ LIQUID AIR CORPOITlON INDUSTRIAL GASES DIVISION e o ~ Material Safety Data Sheet LIQUID AIR CORPORATION INDUSTRIAL OASES DIVISION One California Plazs, Suite 350 2121 N. California Blvd. Walnut Creek, California 94596 tSSUE DATE OCTOBER 1, 1985 AND REVISIONS CORPORATE SAFETY DEPT. PRODUCT NAME OX en TELEPHONE (415) 977-6500 EMERGENCY RESPONSE INFORMATION ON PAGE 2 TRADE NAME AND SYNONYMS CAS NUMBER 7782-44-7 CHEMICAL NAME AND SYNONYMS OX en FORMULA MOLECULAR WEIGHT 31.999 HEALTH HAZARD DATA CHEMICAL FAMILY TIME WEIGHTED AVERAGE EXPOSURE LIMIT None established (ACGIH, 1984-85). Oxygen is the "vital in which we live and breathe (approximately 21 molar % of (' ;~:mentll in th,1 atmosphere SYMPTOMS OF EXPOSURE Breathing high concentrations (greater than 75 molar percent) causes symptoms of hyperoxia which include cramps, nausea, dizziness, hypothermia, ambylopia, respiratory difficulties, bradycardia, fainting spells and convulsions capable of leading to death. For additional data on hyperoxia as it relates to oxygen pressure and exposure duration, refer to L'Air Liquide's Encyclopedie des Gaz. TOXICOLOGICAL PROPERTIES The property is that of hyperoxia which leads to pneumonia. Concentrations between 25 and 75 molar percent present a risk of inflammation of organic matter in the body, Listed as Carcinogen or Potential Carcinogen National Toxicology Yes 0 Program No 181 I.A.RC. Yes 0 Monographs No ¡g¡ OSHA Yes 0 No [8] RECOMMENDED FIRST AID TREATMENT PROMPT MEDICAL ATTENTION IS MANDATORY IN ALL CASES OF OVEREXPOSURE TO OXYGEN. RESCUE PERSONNEL SHOULD BE COGNIZANT OF EXTREME FIRE HAZARD ASSOCIATED WITH OXYGEN-RICH ATMOSPHERES. Conscious persons should be assisted to an uncontaminated area and breathe fresh air. They should be kept warm and quiet. The physician should be informed that the victim is experiencing (has experienced) hyperoxia. c. Unconscious persons should be moved to an uncontaminated area and givèn assisted respiration. When breathing has been restored, treatment should be as above. Continued treatment should be symptomatic and supportive. Judgemenls as to the suitability at intormation herein tor purchaser's purposes are necessarily purchaser's responsibility. Thererore, although reasonable care has been taken in Ihe preparation or such information, Liquid Air Corporation extends no warranties, makes no representations. and assumes no responsibility as to the accuracy or suitability of such information tor application to purchaser's intended purposes or consequences ot its use, Since liquid Air Corporation has no control over the use ot this product, it assumes no liability for damage or loss of product resulting trom proper (vr improper) use or application of the product. Data Sheets may be changed from time to time, Be sure to consult the latest edition. LAC05127 Page 2 ~ZARDPUS MIXTURES OF OTHER UQUIDS, S, OR OASES Oxygen vigorously accelerates combustion. .. ' be avoided. Some materials which are not Contact with all flammable materials should flammable in air will burn in pure oxygen o PHYSICAL DATA BOILING POINT -297.35°F -182.97°C VAPOR PRESSURE @ 70° F (21.1 °C) above the critical tern . of - SOLUBiliTY IN WATER @ 68° F FREEZING POINT coeffi ci ent = ~'0310 -361.838°F -118.574°C APPEARANCE AND ODOR Colorless odorless and @ 70F (Air=1.0) is 1.11. FIRE AND EXPLOSION HAZARD DATA FlAStl POINT (METHOD USED) N A EXTINGUISHING MEOlA Co pi ous ox en as th 'd' SPECIAL FIRE FIGHTING PROCEDURES If possible, stop the flow of oxygen which is supporting the fire. N A quantities of water for UNUSUAL FIRE AND EXPLOSION HAZARDS Vigorously accelerates combustion. ( REACTIVITY DATA STABILITY CONDITIONS TO A VOID Un.teble Steble X INCOMPATIBiliTY (Meterle.. 10 evold) All flammable materials HAZAROOUS DECOMPOSITION PRODUCTS None HAZARDOUS POLYMERIZATION CONDITIONS TO A VOID May Occur Will Not Occur X SPILL OR LEAK PROCEDURES STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPillED Evacuate all personnel from affected area. Use appropriate protective equipment. If leak is in user's equipment, be certain to purge piping with an inert gas prior to attempting repairs. If leak is in container or container valve, contact the closest Liquid Air Corporation location. WASTE DISPOSAL METHOO Do not attempt to dispose of residual or unused quantities. Return in the shipping containe~ properly labeled, with any valve outlet plugs or caps secured and valve (-, ; ~rotection cap in place to Liquid Air Corporation for proper disposal. For emergency ~ isposa1, contact the closest Liquid Air Corporation location. EMERGENCY RESPONSE INFORMATION IN CASE OF EMERGENCY INVOLVING THIS MATERIAL, CALL DAY OR NIGHT (800) 231-1366 OR CALL CHEMTREC AT (800) 424-9300 ; PECIAL PROTECTION INFORMATI N/A To prevent accumulation Page 3 RESPIRATORY PROTECTION (lpecIy frpe) o· VENTILATION To prevent accumula- tion above 2Smolar percent. PROTECT1VE GLOVES As required; any material EYE PROTECTION Safety goggles or glasses OTHER PROTECTIVE EQUIPMENT Safety shoes, safety shower LOCAL EXHAUST SPECIAL MECHANICAL (Gen.) OTHER SPECIAL PRECAUTIONS· SPECIAL LABELING INFORMATION DOT Shipping Name: Oxygen or Oxygen, compressed DOT Hazard Class: Nonflanmable gas DOT Shipping Label: Oxidizer 1.0. No.: UN 1072 SPECIAL HANOLlNG RECOMMENDATIONS Use only in well-ventilated areas. Valve protection caps and valve outlet threaded plugs must remain in place unless container is secured with valve outlet piped to use point. Do not drag, slide or roll cylinders. Use a suitable hand truck for cylinder movement. Use a pressure reducing regulator when connecting cylinder to lower pressure «3000 psig) piping or systems. Do not heat cylinder by any means to increase the discharge rate of product from the cylinder. Use a check valve or trap in the discharge line to prevent hazardous back flow into the cylinder. For additional handling recommendations consult L'Air Llquide's Encyclopedia de Gaz or Compressed Gas Association Pamphlet P-1. (- SPECIAL STORAGE RECOMMENDATIONS Protect cylinders from physical damage. Store in cool, dry, well-ventilated area away from heavily trafficked areas and emergency exits and away from full or empty stored cylinders which contain flammable products. Do not allow the temperature where cylinders are stored to exceed 130F (54C). Cylinders should be stored upright and firmly secured to prevent falling or being knocked over. Full and empty cylinders should be segregated. Use a "first in-first out" inventory system to prevent full cylinders being stored for excessive periods of time. For additional storage recommendations consult L'Air liquide's Encyclopedia de Gaz or Compressed Gas Association Pamphlet P-1. SPECIAL PACKAGING RECOMMENDATIONS Carbon steels and low alloy steels are acceptable for use at lower pressures. For high pressure applications use stainless steels, ~opper and~ts alloys, nickel and its alloys, brass, bronze, silicon alloys, Monel, Inconel or b~ry11ium. Lead and silver or lead and tin alloys are good gasketing materials. Teflo~ and Kel-FGÞare the preferred nonmetal gaskets. Special Note: It should be recognized that the ignition temperature of metals and nonmetals in pure oxygen service decreases with increasing oxygen pressure. For additional information refer to L'Air Liquide's Encyclopedie des Gaz. OTHER RECOMMENDATIONS OR PRECAUTIONS Oxygen should not be used as a substitute for compressed air in pneumatic equipment since this type generally contains flammable lubricants. Equipment to contain oxygen must be "cleaned for oxygen service." See Compressed Gas Association Pamphlet G-4.1. Compressed gas cylinders should not be refilled except by qualified producers of compressed gases. Shipment of a compressed gas cylinder which has not been filled by the owner or with his (written) consent is a violation of Federal law (49CFR). (,.: ·Varl~us Government agencies (i,e., Departme~t 01 Transportation, Occupational Safety and Health Administration, Food and Drug Administration and others) may have speclllC regulations concerning the transportation, handling, storage or use of this product which may not be contained herein. The customer or user of this product should be familiar with these regulations. '. " e ¿:I LIQUID AIR CORPORATION ~ INDUSTRIAL GASES DIVISION e Page 4 o ADDITIONAL DATA ( c -r! LIQUID AIR CORP.ATlON INDUSTRIAL GASES DIVISION e C·'''", -.. , . Material Safety Data Sheet LIQUID AIR CORPORATION INDUSTRIAL GASES DIVISION One California Plaza, Suite 350 2121 N. California Blvd. Walnut Creek, California 94596 ISSUE DATE OCTOBER 1, 1985 AND REVISIONS CORPORATE SAFETY DEPT. PRODUCT NAME Nitrous oxide TELEPHONE (415) 977-6500 EMERGENCY RESPONSE INFORMATION ON PAGE 2 TRADE NAME AND SYNONYMS See last a e. CHEMICAL NAME AND SYNONYMS Nit rou s oxide Dinitro en monoxide FORMULA MOLECULAR WEIGHT N 0 44.01 HEALTH HAZARD DATA CAS Number: 10024-97-2 CHEMICAL FAMILY TIME WEIGHTED AVERAGE EXPOSURE LIMIT None established. It should be considered a simple asphyxiant. Oxygen levels should be maintained at greater than 18 molar percent at normal (Continued on last page.) SYMPTOMS OF EXPOSURE Inhalation: High concentrations of nitrous oxide so as to exclude an adequate supply of oxygen to the lungs causes dizziness, deeper breathing due to air hunger, possible nausea and eventual unconsciousness. (- ~. It is also employed as an anesthetic when mixed with oxygen. These mixtures are generally 80 molar % N20 and 20 molar % 02. (Continued on last page.) TOXICOLOGICAL PROPERTIES Nitrous oxide is a slight narcotic but lacks substantial toxicity. Therefore, its major 'property is the exclusion of an adequate supply of oxygen to the lungs. Listed as Carcinogen or Potential Carcinogen National Toxicology Yes 0 Program No I&J I.A.R.C. Yes 0 Monographs No I&J OSHA Yes 0 No [8] RECOMMENDED FIRST AID TREATMENT PROMPT MEDICAL ATTENTION IS MANDATORY IN ALL CASES OF OVEREXPOSURE TO NITROUS OXIDE. RESCUE PERSONNEL SHOULD BE EQUIPPED WITH SELF-CONTAINED BREATHING APPARATUS. Inhalation: Conscious persons should be assisted to an uncontaminated area and inhale fresh air. Quick removal from the cont~minated area is most important. Unconscious persons should be moved to an uncontaminated area, given mouth-to-mouth resuscitation and supplemental oxygen. Medical assistance should be sought immediately. () Judgements as to the suitability of information herein for purchaser's purposes are necessarily purchaser's responsibility, Therefore, although reasonable care has been taken in the preparation of such ~nformation, liquid Air Corporation extends no warranties, makes no representations, and assumes no responsibility as to the accuracy or suitability of such information for application to purchaser's ~ntended purposes or .consequences of its use. Since liquid Air Corporation has no control over the use of this product, it assumes no liability for damage or loss of product resulting lrom proper (or Improper) use or application of the product. Data Sheets may be changed from time to time. Be sure to consult the latest edition. lAC 05125 / Page 2 ".AUS MIXTURES OF OTHER UQUIDS, S, OR GASES , , ,~i t rous OX i de wi 11 serve as the oxidant for most fl arrunab 1 e compounds. flammables (generally allenes) have a lower lower flammable limit in than in pure oxygen. Powerful reducing agents will react violently with nitrous oxide at room temperatures. Some nitrous oxide n......t ~-) PHYSICAL DATA LIQUID DENSITY AT BOILING POINT 3 76.34 lb/ft3 (1222.8 kg/m ) GAS DENSITY AT 70°F 1 elm .11451b/ft3 1.834 kg/m3 unsen FREEZING POINT -131.5°F (-90.81°C) Specific gravity @70°F (Air = 1.0) sweet taste and odor. is 1.53 FIRE AND EXPLOSION HAZARD DATA BOILING POINT -127.2°F (-88.47°C) VAPOR PRESSURE 754 psia (5200 kpa) SOLUBILITY IN WATER coefficient =.665 APPEARANCE AND ODOR Colorless as with sli FLASH POINT (METHOD USED) N EXTINGUISH'NGMEDIA Copious quantities of water for fires ELECTRICAL CLASSIFICATION nitrous oxide as the oxidizer. Nonhazardous SPECIAL FIRE FIGHTING PROCEDURES If possible, stop the flow of nitrous oxide which is supporting the fire. UNUSUAL FIRE AND EXPLOSION HAZARDS ( REACTIVITY DATA STABILITY CONDITIONS TO AVOID Unstable Stable X INCOMPATIBILITY (Materials to avoid) All flarrunable materials HAZARDOUS DECOMPOSITION PRODUCTS ~one HAZARDOUS POLYMERIZATION CONDITIONS TO A VOID May Occur Will Not Occur X SPILL OR LEAK PROCEDURES STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED Evacuate all personnel from affected area. Use appropriate protective equipment. If leak is in user's equipment, be certain to purge piping with an inert gas prior to attempting repairs. If leak is in container or container valve, contact the closest Liquid Air Corporation location. WASTE DISPOSAL METHOD , Do not attempt to dispose of residual or unused quantities. Return in the shipping container properly labeled, with any valve outlet plugs or caps secured and valve C..,: protection cap in place to Liquid Air Corporation for proper disposal. For emergency disposal, contact the closest Liquid Air Corporation location.. EMERGENCY RESPONSE INFORMATION IN CASE OF EMERGENCY INVOLVING THIS MATERIAL, CALL DAY OR NIGHT (800) 231-1366 OR CALL CHEMTREC AT (800) 424-9300 SPECIAL PROTECTION INFORMATION PagB 3 : '" TORY PROTECTtON (Spec., type) ðreathing apparatus shoul be available VENTlUlTtON LOCAL EXHAUST See local Exhaust on See last a e. last page. MECHANICAL (Oen.) r....\ ~. OTHER SPECIAL PRECAUTIONS· SPECIAL LABELING INFORMATtON DOT Shipping Name: Nitrous oxide or Nitrous oxide, compressed I.D. No.: UN 1070 DOT Shipping Label: Nonflammable gas DOT Hazard Class: Nonflammable gas SPECIAL HANDLING RECOMMENDA TtONS Use only in well-ventilated areas. Valve protection caps and valve outlet threaded plugs must remain in place unless container is secured with valve outlet piped to use point. Do not drag, slide or roll cylinders. Use a suitable hand truck fQr cylinder movement. Use a pressure reducing regulator when connecting cylinder to lower pressure «1500 psig) piping or systems. Do not heat cylinder by any means to increase the discharge rate of product from the cylinder.. Use a check valve or trap in the discharge line to prevent hazardous back flow into the cylinder. For additional handling recommendations consult L'Air Liquide's Encyclopedia de Gaz or Compressed Gas Association Pamphlet P-1, SPECIAL STORAGE RECOMMENDATIONS (- Protect cylinders from physical damage. Store in cool, dry, well-ventilated area away ~. from heavily trafficked areas and emergency exits and away from fulì or empty stored cylinders which contain flammable products. Do not allow the temperature where cylinders are stored to exceed 130F (54C). Cylinders should be stored upright and firmly secured to prevent falling or being knocked over. Full and empty cylinders should be segregated. Use a "first in-first out" inventory system to prevent full cylinders being stored for excessive periods of time. For additional storage recommendations consult L'Air Liquide's Encyclopedia de Gaz or Compressed Gas Association Pamphlet P-1, SPECIAL PACKAGING RECOMMENDATIONS Nitrous oxide is noncorrosive and may be used with any common structural material, Nitrous oxide oxidizes some metals at elevated temperatures. See L'Air Liquide's Encyclopedie des Gaz. OTHER RECOMMENDATtONS OR PRECAUTIONS Compressed gas cylinders should not be refilled except by qualified producers of compressed gases. Shipment 'of a compressed gas cylinder which has not been filled by the owner or with his (written) consent is a violation of Federal Law (49CFR). C.'; ·Varlous Government agencies (i.e., Department of Transportation, Occupational Safety and Health Administration, Food and Drug Administration and others) may have specific regulations concerning the transportation. handling, storage or use of this product which may not be contained herein. The customer or user 01 this product should be familiar with these regulations. , . . .~~ LIQUID AIR CORPO"ON ~ INDUSTRIAL GASES DIVISION e ADDITIONAL DATA TRADE NAME AND SYNONYMS: (Continued) Nitrous oxide, Dinitrogen monoxide, Laughing gas .' TIME WEIGHTED AVERAGE EXPOSURE LIMIT: (Continued) atmospheric pressure which is equivalent to a partial pressure of 135 mm Hg. (ACGIH, 1984-85). SYMPTOMS OF EXPOSURE: (Continued) The laughter effects seem to occur after incipient asphyxia accompanied by the sudden return of adequate oxygen as in the air. LOCAL EXHAUST: (Continued) To prevent accumulation of high concentrations so as to reduce the oxygen level in the air to less than 18 molar percent. Page 4 p..¡ ~f , (" (,,' WRIttEN . pfl(jGtlAM e e The hazard communication program consists of the inventory of hazardous chemicals contained in Chemical Inventory section of this binder, the labeling displayed on the containers holding the chemicals, the material safety data sheets (MSDSs) contained in the Dental Office MSDS secûon, and the self-study training hand- book which accompanies this program or the training the employee has received in seminars or similar classes on the safe handling and use of chemicals. After reading the handbook and passing a written or oral examina- tion on the HCP and chemical safety, each employee shall sign a fonn stating they reviewed the written materials outlined above and received the safety training conducted by the dental practice. This training should take place at the time of initial employment. Before any new hazardous chemical is introduced into the dental office, each employee will be given infonnaûon on its safe han- dling and use and potenûal hazards. The dentist, office manager or designated Hazard Communication/lnfection Control Officer (HC/lCO) will be responsible for seeing that the MSDSs on the new chemical are available. A list of the hazardous chemicals used in this office is contained in the Chemical Inventory section of this Hazard Communication Program manual. Ordinary office supplies, such as correcûng fluid, copy machine toner and general purpose cleaners such as those used in the home are not hazardous chemicals as defined in the Hazard Communication Standard (HCS) and are not covered by this program. a. Container Labeling The dentist, office manager or HC/lCO will verify that all chemi- cals received for use by this practice: · Are clearly labeled as to the contents; · Are labeled with appropriate hazard warnings; · List the name and address of the manufacturer. No chemicals or their containers will be released for use until the above infonnation is verified. a) The employer shall ensure that each container of hazardous chemicals in the workplace is labeled, tagged or marked with the following infonnation: 1- 2 HAZARD COMMUNICATION PROGRAM e e I· Written Hazard Communication Program Mark A. Kinnsch, D.M.D. 1. General Dental Practice Policy The following written Hazard Communication Program (HCP) has been prepared for the dental practice of Mark A Kinnsch, D.M.D. . This notice is to inform you that the dental practice of Mark A. Kinnsch, D.M.D. is complying with the OSHA Hazard Communication Standard, Title 29, Code of Federal' Regulations 1910.1200 by compiling a hazardous chemicals list, by using Material Safety Data Sheets, by ensuring that containers are labeled and by providing you with training. ' The purpose of the Hazard Communication Standard is to provide you with information and training that will help you protect yourself against hazardous substances and blood-borne diseases in the workplace. Under this program, you will be informed of the contents of the Hazard Communication Standard, the hazardous properties of substances with which you work, the handling procedures, measures to take to protect yourself from these substances, and standard operating procedures for infection control in the dental office. The program will be available in the business office of the practice at 6001 D Truxtun Extension, STE 490, Bakersfield, CA for review by all employees during normal business hours. This program is available to all employees and their designated representatives upon'request. To be a designated representative a person must have written authorization to exercise the employee's rights to access to the hazard communication program. "Employee" means a person who may be exposed to hazardous chemicals under normal operating conditions or in foreseeable emergencies. Workers such as office workers who encounter hazardous chemicals only in non-routine, isolated instances are not covered. All employers of one or more employees except federal government employees and native Americans employed on reservations must develop a hazard communication program. The materials contained in this binder constitute the hazard communication program for Mark A. Kinnsch, D.M.D. . \, '- HAZARD COMMUNICATION PROGRAM 1-1 e WRIttEN ÞRtJGRAM" e · Chemicals and related hazards in your work areas, · Infection control in the dental office, · Procedures to follow if you should be exposed to che~cals through the skin, mouth or eyes. · Procedures to protect against hazards, including the use and lnaintenance of personal protective equipment, proper use and handling of chemicals, and procedures for emergency response. 2. List of Hazardous Chemicals The list of hazardous chemicals used in this dental practice is contained in the Chemical Inventory section of this hazard com- \ munication program. Funher information on each hazaJ:'dous chemical noted can be obtained ~y reviewing the material safety data sheet contained in the MSDS section of the binder. 3. Hazardous Non-routine Tasks If three to four times a year or at other infrequent intervals' an employee is required to perform tasks which are of a non-routine nature, prior to starting work on such a task each employee will be given information by the supervising dentist about the hazards involved with the task(s). This information will include: · Specific chemical hazards; · Protective/safety measures the employee must observe; · Protective/safety equipment the employee must wear; and · Measures the office has taken to lessen the hazards as- sociated with the task. In the course of your job in this dental office you may come in contact with various kinds of disinfectants and laboratory chemi- cals. However, these are normal activities and you will be provided proper instruction in their use and handling and be provided with appropriate protective clothing. There are no non-routine hazard- ous tasks which you will be asked to perform while an employee of this practice. 4. Chemicals in Unlabeled Pipes Nitrous Oxide. There are no exposed pipes in areas accessible to 1- 4 HAZARD COMMUNICATION PROGRAM . - . - - -- - . -.~ . -- . . -, -.- - --- e i) Identity of thé hazardous chemical(s) contained therein; and ü) Appropriate hazard warnings. b) The employer is not required to label portable containers into which hazardous chemicals are transferred ftom·labeled con- tainers, and which are intended only for the immediate use of the employee making the transfer. . c) The employer shall not remove or deface existing labels on incoming containers of hazardous chemicals. d) New labeling does not need to be applied to containers which already have labels with the information required in this section. All disinfectants used in dental offices are registered pesticides. Pesticides have the required labeling including the name and percentage of active ingredients, use directions and appropriate physical and safety warnings. If concentrated disinfectants are diluted for use, the container an employee works from should have the name of the chemical, its primary use (disinfectant, sterilizer) and the appropriate toxic signal word (Caution, Warning, DangerlPoison). b. Material Safety Data Sheets (MSDSs) Copies of MSDSs for all hazardous chemicals to which employees may be exposed are contained in Material Safety Data Sheet section of this booklet which will be kept in the dentist's office. MSDSs will be available for review by all employees during each work shift and during normal working hours. c. Employee Training and Information Every employee who works with or is potentially exposed to hazardous substances will receive initial training on the Hazard Communication Standard and safe work practices. Each covered employee will read and show understanding of the basics of the hazard communication program and the safe handling of chemicals by passing a written or oral examination of the "Hazard Com- munication Training Manual for Dental Health Care Workers" provided with this publication. Each employee also will demonstrate knowledge of modes of transmission of blood-borne pathogens and protective measures required to prevent transmis- sion of blood-borne diseases. Each new employee will be expected to do this at time of initial employment The training manual contains information on: ''-- " e WRITtEN Þl¡IlJGIlAM' . I ' HAZARD COMMUNICATION PROGRAM I- 3 . e employees. Nitrous Oxide IS piped into the patient treatment rooms' and the connector is labeied at the wall outlet. Connectors are such that only the connector for nitrous oxide will fasten to the nitrous oxide outlet. Oxygen. There are no exposed pipes in areas accessible to employees. Oxygen is piped into the patient treatment rooms and the connector is labeled' at the wall outlet. Connectors are such that only the connector for oxygen will fasten to the oxygen ~utlet. 5. Informing Contractors (including temporary dental staff) It is the responsibility ,of the dentist or office manager to provide temporary employees and their employers with the following information. · The MSDSs for the hazardous chemicals to which they may be exposed while on the job; · Measures the employees may take to lessen the possibility of exposure (i.e. protective clothing, etc.); · How to interpret the in-house labeling system for containers of hazardous chemicals. MSDSs for all hazanlous chemicals are on file in the business office of this practice. TIle dentist, office manager or HC/lCO will coordinate with the contractor to ensure a contractor's employees are given this information prior to beginning work. 6. Contractors Informing Employers Contractors entering this dental practice with hazardous materials shall supply the dentist with MSDSs covering those particular products the contractor may expose the dentist's employees to while working in this office. I \ '--' ~ e I WRIttEN PflOGílAM ' , I HAZARD COMMUNICATION PROGRAM I- 5 e Bakersfield Fire Dlt. Hazardous Materials DiVI ion TO: PLANNING DEPT. <=-. BUILDING DEPT:--, rf/;ke quon- (YÎ~rl A. K(ìn~rl , D,N,D, 'BUSINESS NAME LOCATION fV1e(lu medicof ~('\<. \ <ó()O I 0 Tr ¡) x+un Äv ( #4CJO STATUS OF HAZ MAT REGULATIONS I. 0 Required to complete a Hazardous Materials Business Plan ~. , Hazardous Materials Business Plan Camplete II. 0 Risk Management & Prevention Program Required o Risk Management & Prevention Program Requirements are being met - OK to issue permit o Risk Management and Prevention Program has been approved. OK to issue Certificate of Occupancy. III. 0 No Hazardous Material Requirements. !.rJ:kcl ÐMG/~ H6zardous aterials Division Id--dd-~t- Date FD 1655 e Bakersfield Fire re>t. Hazardous Materials Division TO: PLANNING DEPT. BUILDING DEPT. BUSINESS NAME (-rYlOJtJ¿ A· ~cA . D ~1 0 J tDuru1.d, ~0Jl,L./ I , LOCATlO~~ IfltoLLUb (1Jl) &1J(2 L i2 ~~k TÍ 1ttD STATUS OF HAZ MAT REGULATIONS I. ~qUired to complete a Hazardous Materials Business Plan o Hazardous Materials Business Plan Complete II. 0 Risk Management & Prevention Program Required o Risk Management & Prevention Program Requirements are being met· OK to issue permit o Risk Management and Prevention Program has been approved. OK to issue Certificate of Occupancy. III. D No Hazardous Material Requirements. l{J~ ~t(}tJ£)aJ Hazardous Materials Division ¡1-d.-7-21 Date FD 165: e Bakersfield Fire D~t. . Hazardous Materials Di~on Se-rct: t=õ e..('f'¡ 5 HAZARDOUS MATERIALS COMPLIANCE STATEMENT (To be completed by Building Permit Applicant and/or Site Plan Review Applicant) . BUSINESS NAME Mark A. Kinnsch,D,M.D. Dental CaJe LOCATION Mercy Medical Park, 600lD Truxton Ave.,Ste.490 PLEASE READ All OF THE INFORMATON CAREFUllY, FAILURE TO COMPLY WITH THE HAZARDOUS MATERIALS REGULATIONS MAY RESULT IN CIVIL LIABILITIES OF UP TO $2000.00 FOR EACH DAY IN WHICH THE VIOLATION OCCURS. Will the Applicant or future building occupant be required to complete a Hazardous Materials Business Plan? @~ (NOTE) If you handle, store, use' or dispose of, reportable quantities of any hazardous substance, you are required by California law to complete a Hazardous Materials Business Plan. Forms can be obtained from the Bakersfield Fire Deparfment. Hazardous Materials Division. 2130 G Street. Typical every day hazardous materials you may find In your facilities may Include, but not limited to: compressed gases; fuels - all types; solvents; oils (new and waste); thinners; caustic or corrosive materials; poisonous Or toxic materials; and radioactive materials. Will the applicant or future building occupant be required to complete a Risk Manage- ment and Prevention Program? YES o (NOTE) If you handle, store, use or dispose of reportable quantities of any extremely hazardous substance you must develop a Risk Management and Prevention Program. THIS PLAN MUST BE APPROVED BY THE LOCAL ADMINISTERING AGENCY BEFORE YOU COMMENCE OPERATIONS AT THIS FACILITY. The list of regulated chemicals is contained in Appendix A of part 355 of Subchapter J of Chapter I of Title 40 of the Code of Federal Regulations. This list of chemicals isavailable at the Bakersfield Fire Department, Hazardous Materials Division, 2130 G Street. Will the applicant or furture building occupant be required to obtain a permit from the Kern County Air Polution Con!rol District? YES o Location within 1,000 feet of outer boundry of the following: YES School -(any school. public or private used for the purposes of education of children Kindergarten or any of grade 1 to 12. Inclusive) D o D Hospital - Long Term Care Facility - Check here if none of the above apply to this project. D Date: l 0- z, -7r1 11-~-8C¡ NO [!] NO ~ NO o o o [!J FD 1654 - e ~ f& /ùf1J -I¡; ~ ¢~r