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Hazardous Materials/Hazardous Waste Unified Permit
"..CONDITIONS.OF.·PE~M.IT ON REVERSE SIDE
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Permit ID #:: 015-000-001974
Issued by:
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Bakersfield Fire Department
OFFICE OF ENVIRONMENTAL SERVICES'
1715 Chester Ave., 3rd Floor
Bakersfield, CA 93301
Voice (661) 326-3979
FAX (661) 326-0576
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This pennlt Is Issued for the following:
~ Hazan:!lous Materials Plan
Q Underground Storage of Hazan:!lous Materials
Q Risk Management Program
Q Hazan:!lous Waste On-Site Tli'88tment
: Approved by:
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Issue Date
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: June 30, 2003
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F/E=FIRE EXTINGUISHER
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Truxtun Ave
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SOUTHWEST URGENT CARE CENTER, INC.
6401 TRUXTUN A VENUE
BAKERSFIELD, CA 93309
HAZARDOUS
MATERIALS
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ENTRANCE
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AUTOMA TIC SPINKLER THROUGHOUT
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"""Southwest Urgent Care ce~r
Jorge E, del Tom, M,D.
Luis A. Cousin, M.D.
Michael 0, Thorpe, M.D,
June 5,2001
City of Bakersfield
Office Of Environmental Services
1715 Chester Ave.
Bakersfield, CA 93301
Attention: Esther Duran
RE: Site/Facility Diagram
To Whom It May Concern:
Enclosed please find a diagram that was requested by your office, If you have any questions
regarding this matter, please feel free to contact me.
Sincerely,
Teresa M, Pena
Office Manager
6401 Truxtun Avenue. Bakersfield, CA 93309 . (805) 322-2273
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BAKERSFIELD
FIRE DEPARTMENT
ENVIRONMENTAL SERVICES
1715 Chester Ave. · Bakersfield, CA 93301
Business Phone (661) 326-3979 · FAX (661) 326-0576
FAX Transmittal
TO: 'Y:::Vcr
COMPANY: ~~LM~ C~
FROM: ~
FAX No. 32;- f'";} -=s I
COMMENTS:
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The req~irements of Article 2 of Chapter 6.95 of the Health and Safety Code
concerning acutely hazardous materials.
F.
The requirements of subdivisions band c of Section 80.103 of the Uniform
Fire Code. concerning hazardous materials management plans and
inventories.
8.60.030
City Enforcement.
The Environmental Services division of the Bakersfield City Fire Department shall
be responsible for the implementation of the Unified Program within the incorporated area
of the City of Bakersfield.
71J4o Additional Materials ReguJateII. _______________.
, For the im~lementation of Article 1 of Chapter 6.95 (CO~h Section
25500) of the California Health and Safety Code, as part of the Unified Prògram. the
following materials shall be reported as part of the Hazardous Materials Invento~ies:
A.
Explosives in any quantity.
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Hazardous Waste in any quantity.
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8.60.050
Underground Storage Tank Cleanup Fund.
The City hereby adopts the ·Petroleum Underground Storage Tank Cleanup" law.
Chapter 6.15 of Division 20 of the California Health and Safety Code. and the regulations
which implement it, including, but not limited to, Title 23. California Code of Regulations.
Chapter 16, Article XI and Chapter 18. The Office of Environmental Services of the Fire
Department of the City of Bakersfield shall be responsible for the implementation and
enforcement of Chapter 6.15 of the California Health and Safety Code.
8.60.060
Fee Collection System.
Pursuant to Article 6.11 of the California Health and Safety Code (commencing with
section 25404, et seq.), the City of Bakersfield hereby institutes the single fee system and
collection of state surcharge revenues as set forth therein. The fees collected for
administration of this program shall be set forth per Bakersfield Municipal Code Chapter
3.70. Charges and fees collected hereunder shall be due and payable on the first day of
the month and become delinquent after the last day of the month. Interest at the rate of
one percent per month shall be added to any charge which is delinquent. Should the City
initiate court action to collect amounts due. the City shall be entitled to collect reasonable
incurred costs,
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06/12/00
12:08
'8'661 326 0576
BFD HAZ MAT DIV
I4J 001
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*** ACTIVITY REPORT ***
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TRANSMI SS ION OK
TX/RX NO. 6279
CONNECTION TEL 3271231
CONNECTION ID
START TIME 06/12 12:06
USAGE TIME 02'15
PAGES 4
RESULT OK
FIRE CHIEF
RON FRAZE
ADMINISTRATIVE SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
SUPPRESSION SERVICES
2101 "H" Street
Bakersfield, CA 93301
VOICE (661) 326-3941
FAX (661) 395-1349
PREVENTION SERVICES
1715 Chester Ave.
Bakersfield, CA 93301
VOICE (661) 326-3951
FAX (661) 326-0576
ENVIRONMENTAL SERVICES
1715 Chester Ave,
Bakersfield, CA 93301
VOICE (661) 326-3979
FAX (661) 326-0576
TRAINING DIVISION
5642 Victor Ave,
Bakersfield, CA 93308
VOICE (661) 399-4697
FAX (661) 399-5763
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May 3,2001
Southwest Urgent Care
6401 Truxtun Avenue
Bakersfield, CA 93309
Dear Business Owner:
Enclosed, please find the Site and Facility Diagram Instructions packet. When your
Hazardous Materials Management Plan and Inventory were submitted it was lacking
the diagram portion. Please draw and submit the diagram( s) of your facility by
June 8, 2001.
The diagram should include the following:
1)
2)
3)
4)
5)
6)
7)
8)
name of your business;
business address;
indicate which direction is North;
the cross streets neighboring business addresses (within 300 feet)
entrances and exits
location of utility shut-off's;
location of the nearest fire hydrant;
portions of the building protected by automatic sprinkler system; and most
importantly
the location of the hazardous materiaI(s),
9)
If you have any questions, please feel free to call me at (661) 326-3658,
Thank you for your assistance.
Sincerely,
RALPH E. HUEY, DIRECTOR
OFFICE OF ENVIRONMENTAL SERVICES
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Esther Duran, Accounting Clerk II
Office of Environmental Services
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Enclosures
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,./o..,./ú~~ ÚlI} r.H'/N/.nU/I.Û'?, .'Y'lJ/~ ./i4.:Joper ,%a/¿, ,jO 6~·'/thl'~r
~UlflentCam ~I
Michael D. Thorpe, M.D.
Diplomate American Board of Family Practice
Senior Aviation Medical Examiner
(661) 321-3465
6401 Truxtun Avenue 0 Bakersfield, California 93309
o DELETE
e CITY OF BAKERSFIeÐ
OFFICE OF ENVIRONMENTAL SERVICES
1715 Chester Ave., CA 93301 (805) 326-3979l
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o REVISE
200
US MATERIALS INVENTORY
Chemical Description Form
(one form per material per building or area)
Page of
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CAf.(.1;
1 MAP # (opOonaf)
203
o Yes 0 No 202
204
CHEMICAL LOCATION
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. . !1:Ç~E,:,MIÇ~~JN~ORMI\TI()~i,i;
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CHEMICAL NAME
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o Yes 0 No 206
If Subject to EPCRA, refer 10 iinstructions
207
COMMON NAME
EHS'
o Yes 0 No 208
CAS #
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209 /i:s~!"!S!~"Yes',an amOUri~belOwniustbelrí,·,
FIRE CODE HAZARD CLASSES (Complete II requested by local fire chief)
210
lYPE o p PURE o m MIXTURE J4- WASTE 211 RADIOACTIVE DYes GNo 212 CURIES 213
PHYSICAL STATE o s SOLID e'þ LIQUID OgGAS 214 lARGEST CONTAINER 7 215
FED HAZARD CATEGORIES 01 FIRE o 2 REACTIVE o 3 PRESSURE RELEASE 04 ACUTE HEALTH fir 5 CHRONIC HEALTH 216
(Check all that apply)
ANNUAL WASTE 9:> 217 MAXIMUM ~ 218 AVERAGE '2.... 219 STATE WASTE CODE 220
AMOUNT DAILY AMOUNT DAILY AMOUNT
UNITS' ~ ga GAL o cf CU FT o Ib LBS o In TONS 221 DAYS ON SITE 222
. If EHS. amount must be In Ibs.
STORAGE CONTAINER
(Check all that apply)
o a ABOVEGROUND TANK
o b UNDERGROUND TANK
DC TANK INSIDE BUILDING
o d STEEL DRUM
'ª e PLASTIClNONMETALLlC DRUM
01 CAN
o g CARBOY
o h SILO
o I FIBER DRUM
OJ BAG
Ok BOX
o CYLINDER
o m GLASS BOTTLE
o n PLASTIC BOTTLE
o 0 TOTE BIN
o p TANK WAGON
o q RAIL CAR
o r OTHER
223
STORAGE PRESSURE
.æ a AMBIENT
o aa ABOVE AMBIENT
o ba BELOW AMBIENT
224
a AMBIENT
o aa ABOVE AMBIENT
o ba BELOW AMBIENT
o c CRYOGENIC
225
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226 ~t(,¡c...~
2 230
3 234
4 238
5 242
227 DYes oNo 228
231 o Yes 0 No 232
235 o Yes 0 No 236
239 o Yes 0 No 240
243 o Yes 0 No 244
229
233
237
241
245
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OES FORM 2731 (7/98)
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CITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
FACILITY NAMESw ~'-<vT c.A.(2:E
INSPECTION DATE S7t 7(97
EPA ID # CÆL- D:XJ1t I S-7 4-
Section 4:
Hazardous Waste Generator Program
fl Routine
o Combined
o Joint Agency
o Multi-Agency
o Complaint
o Re-inspectíon
OPERATION C V COMMENTS
Hazardous waste determination has been made v ¡..-
EPA ID Number (Phone: 916-324-17R I to obtain EPA ID #) V
Authorized for waste treatment and/or storage t/
Reporkd release, tire, or explosion within IS days of occurance ~ ~
Established or maintains a contingency plan and training t/ tlC'1\lDðfL ~OC-O
Hazardous waste accumulation time tì'ames ¿/
Containers in good condition and not leaking V ;"
Containers are compatible with the hazardous waste V ;"
Containers are kept closed when not in use ..A:f.p/'o.Y'S (ftJ <JS€ w/ tJeJse
Weekly inspection of storage area V
Ignitable/reactive waste located at least 50 feet from property line I~ ~
Secondary containment provided ¡J ~
Conducts daily inspection of tanks .
Used oil not contaminated with other hazardous waste /' V
Proper management of lead acid batteries incJuding labels ./ Þ
Proper management of used oil filters (
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Transports hazardous waste with completed manifest
Sends manifest copies to DTSC I 7:fj:::..(t:if7'> r.tw- $,v¡ ,
Retains manifests for 3 years ....
Retains hazardous waste analysis for 3 years <\
Retains copies of used oil receipts for 3 years /
Determines if waste is restricted hom land disposal '"
c=com:~ Y=Yiolation pÞ d~4,
Inspecto'. W ¡A(2s
Oftïce of lVironmental Services (805) 326-3979
\\'hite - Env. Svcs.
Business Site Responsible Party
Pink - Business Cory