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HomeMy WebLinkAboutBUSINESS PLAN 10/19/2006~• Kern Cardiology Medical Group bF_ ~ ~ 2323 16th St 305 `\ l - UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1: Business Plan and Inventory Program • Prevention Services ' A ~~ E R s F~ n ~ 900 Truxtun Ave., Suite 210 FIRE . Bakersfield, CA 93301_ ARTM r Tel.: (661) 326-3979 2171 661) 872 F x: - - a - ( FACILITY NAME - INSPECTION DATE INSPECTION TIME ~. C ~ ° ol~ m t~lG ~ ~ -~ -ate ~ ~s ADDRESS c l ~ Z~ ~ ~~~ Sf~- ~~~ PHO~NfE^NO. ~L i^"© ~~ NO OF EMPLOYEES FACILITY CONTACT - BUSINESS ID NUMBER - - 15-021-~27 Z~-' ~~ Section 1: Business Plan and Inventory Program -- ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance .OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSlflt?SS 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 ,~/~ ~ ~J ~/ ^ ~ VERIFICATION OF HAZ MAT TRAINING O ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES f~ ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ~I, ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: Q~STIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 C ~r~,/ G6~JG / Inspector ( le se Print) Fire Prev ion / 1st In /Shift of Site/Station # Business Site /Responsible Party ( ease Print) . . White - revention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 ^ YES f~NO + KERN CARDIOLOGY MEDICAL GROUP _______________________ SitelD: 015-021-402225 + Manager Location: 2323 16TH ST 305 City BAKERSFIELD CommCode: BFD STA O1 EPA Numb: BusPhone: (661) 327-0807 Map 102 CommHaz Low Grid:- 25D FacUnits: 1 AOV: SIC Code: DunnBrad:77-045734 Emergency Contact / Title Emergency Contact / Title DR SABARJIT SINGH / OWNiER JIMMIE RODGERS / NUC MED TECH Business Phone: (661) 32'T-0807x Business Phone: (661) 327-0807x 24-Hour Phone ( ) - x 24-Hour Phone (661) 589-9212x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth l " ~f `Y'~O''~ Contact d-3-MM3E ~@HGF~ --Yh~ ` 0 Phone: (661) 327-0807x MailAddr: 2323 16TH ST 305 State: CA City BAKERSFIELD Zip 93301 Owner DR SABARJIT SINGTi Phone: (661) 327-0807x Address 2323 16TH ST 305 State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No __ - .~ - ParcelNo: Emergency Directives: PROG A - HAZMAT Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalt of law that I have personally examined a a familiar with the information submitted nd b lieve the info ation is true, accurate, co plete. 3~7 ~~d Date ~~~'p M,~~ .~ ~ ~~o -1- 02/28/2006 ~~g~ ~,~ KERN CARDIOLOGY MEDICAL GROUP SiteID: 015-021-002225 Manager ~r-i/t..k~ji ~ ~1r~h Y1r1_~, BusPhone: (661) 327-0807 Location: 2323 16TH ST 305 Map 102 CommHaz Low City BAKERSFIELD Grid: 25D FacUnits: 1 AOV: CommCode: BFD STA Ol SIC Code: EPA Numb: DunnBrad:77-045734 Emergency Contact / Title Emergency Contact / Title DR SABARJIT SINGH / OWNER -J3 / * n"' *Rr„ mr,.V Business Phone: (661) 327-0807x Business Phone: (661) 327-0807x 24 -Hour Phone ( ) - x 24 -Hour Phone ( 661) ~ ° ° -°'" °-x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact : -3~iFP~-D~P3£~4Pd L e'~' +0.10.. ~ t,~ +n~1~~ Phone : ( 6 61 } 3 2 7 - 0 8 0 7 x MailAddr: 2323 16TH ST 305 State: CA City BAKERSFIELD Zip 93301 Owner DR SABARJIT SINGH Phone: (661) 327-0807x Address 2323 16TH ST 305 State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ENT°D MAC ~ ~flQ7 Based on my inquiry of t~ se individU~ls ` responsible for obtainin th ~ 'nfc~mation, I certify O w ~ under penalty of lav. h• t I h eve personally ~" \ examined and am ft , i is ,Kith he infeart~lation ~ submitted and beii a tY a infer nation is true, accurate, and compl.,t . J~6 Signature Date -1- 02/02/2007 F KERN CARDIOLOGY MEDICAL GROUP SiteID: 015-021-002225 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F IH DH G 2300.00 FT3 Low -2- 02/02/2007 -3- 02/02/2007 S P KERN CARDIOLOGY MEDICAL GROUP SiteID: 015-021-002225 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this, Facility Unit Map: Grid: STRESS LABS 1 & 2 CAS# 7782-44-7 ~GasATE TPureE ~-AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1150.00 FT3 2300.00 FT3 1150.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 i'lEiGHKL HJ 47 P~.7 J1"181V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -4- 02/02/2007 F KERN, CARDIOLOGY MEDICAL GROUP SiteID: 015-021-002225 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 07/23/2001 ~ E TANK, OXYGEN, WITH REGULATORS. Employee Notif./Evacuation 07/23/2001 911. Public Notif./Evacuation 07/23/2001 OFFICE MANAGER IS TO REPOND TO EMERGENCY AGENCY, THEN TO PRESIDENT OF KERN CARDIOLOGY MEDICAL GROUP, SARABJIT SINGH, MD. Emergency Medical Plan 07/23/2001 911. -5- 02/02/2007 4' F KERN, CARDIOLOGY MEDICAL GROUP SiteID: 015-021-002225 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 07/23/2001 ~ OXYGEN TANKS ARE SECURED TO CARTS AND ARE OUT OF FOOT TRAFFIC FOR SAFETY. TANKS ARE CHECKED BY SUPPLIER MONTHLY FOR LEAKS. Release Containment 07/23/2001 OXYGEN TANKS ARE SECURED TO CARTS AND ARE OUT OF FOOT TRAFFIC FOR SAFETY. TANKS ARE CHECKED MONTHLY BY SUPPLIER FOR LEAKS. Clean Up 07/23/2001 OXYGEN ONLY. V1.11C1 iCCSVUlUC Hl.:L1VCLL1V11 -6- 02/02/2007 ` / F KERN~CARDIOLOGY MEDICAL GROUP SiteID: 015-021-002225 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ especial nazarus Utility Shut-Offs 02/02/2007 A) GAS - ON ROOF B) ELECTRICAL - SUB PANELS IN UTIL RM C) WATER - INSIDE RM FRONT OF BLDG D) SPECIAL - NONE E) LOCK BOX - OVER ELEVATOR RM FRONT OF BLDG AND BLDG MGR FOR MERCY HOSPITAL, ROGER YATES 322-7081. Fire Protec./Avail. Water 05/18/2006 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS AND SPRINKLERS. NEAREST FIRE HYDRANT - CRNR A ST & 16TH 5T. Building Occupancy Level 02/28/2006 6 EMPLOYEES -7- 02/02/2007 ~` _ KERN~CARDIOLOGY MEDICAL GROUP SitelD: 015-021-002225 ~ Fast Format ~ / ~ Training Overall Site ~ I` ~ Employee Training 11/22/2006 ~ BRIEF SUMMARY OF TRAINING PROGRAM: KERN CARDIOLOGY MEDICAL GROUP INC HAS AN EXPOSURE CONTROL PLAN THAT PROVIDES PRACTICAL, DETAILED GUIDANCE FOR COMPLIANCE FOR ALL OF OUR HAZARDOUS MATERIALS. THE MSDS SENT TO US FROM OUR MEDICAL SUPPLIERS ARE KEPT IN A FILE AND ARE GIVEN TO THE APPROPRIATE DEPARTMENTS. KERN CARDIOLOGY MEDICAL GROUP INC HAS YEARLY TRAINING AND TESTING OF ALL EMPLOYEES ON THE SAFETY OF OUR NUCLEAR THALLIUM LAB. rayc ~ nciu ivi rut...u.LC vac nc.~u tvL r uLUiC ~~~ -8- 02/02/2007 • • UN11=1ED PROGRAM INSPECTION CHECKLIST SECTION 7 Business .Plan and Inventory Program Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel: (661) 326-3979 FACILITY NAME INSPECTION DATE INSPECTION TIME / ~ ~ _ _ _ - -- ADDRESS ~ ~ PHONE No No. of Em loyees P 323------./~_..---_----.-.--.~-~.____ z~-o8o7 ~ __ FACILITYCONTACT ~ Business 10 Number ~,I,~, 15-021- Section 1: Business Plan and Inventory Program Routine O Combined O Joint Agency OMulti-Agency O Complaint O Re-inspection ANY HAZARDOUS WASTE ON SITE: OYES {LI IVO EXPLAIN: • QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 __,:-~------ eat --------- __ ___~~- ~ ______ : _ Inspector (Please Print) Fire Prevention 1st-In/Shift of Site White • EnvironmenUl Services Yellow - Stettin Copy _ _ uslness Site R arty (Pleas rn S N Pink • Business Copy ~ s CITY OF BAKF,RSFIEI.D FIRE DEPARTMENT OFFICE OF ENVIRt)NMENTAL SERVICES UNIFIED PROGRAM INSPECTION CiIECKLIST 1715 Chester Ave., 3rd I~ loor, Bakersfield, CA 93301 p~T 24 2~ FACILITY NAME_,,~ot'~ CA~~ o La6~ INSPECTION DATE I O-2 Z ' a3 _ ADDRESS Z Sup 3os PHONE NO. 3Z7 ~o d''u'7 FACILITY CONTACT Si~G BUSINESS iD NO. 15-210- 21 ~- s INSPECTION TIME l n V-~- ~ N~~r NLIMBFR OF EMPLOYEES_~~ Section 1: Business Plan and Inventory Program ~outine ^ Combined ^ Joint Agency ^MuIti-Agency () Complaint ^ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material '- Verification of MSDS availability Verification of Haa Mat training Q,~~ Verification of abatement supplies and procedures ~~~ ~ ~ ~'7 ~ ~ Emergency procedures adequate i ~ - ~ ~' D 3 Containers properly labeled Housekeeping Fire Protection '~ Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: ^ Yes ~No Explain: Questions regarding this inspection'! Please call us at (66l) 326-3979 Whirr -Env. Svcs. Yellow -Station Copy Pink -Business Copy usiness Site Respon ' e Party Inspector: C