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Home My WebLink AboutBUSINESS PLAN (3)i f Planned Parenthood Mar Monte - - - 2535 16t" St 100 . - . - .. - _ - _ _ - ----3 } - Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST e F R s F, 9ooTruxtunAve., suite2lo _~_ F,'Re Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program aRrM t Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME f INSPECTION DATE INSPECTION TIME ADDRESS ZS'3 /G f~ ~,-~~- PHONE NO. ~3y -imoo NO OF EMPLOYEES FACILITY CONTACT ~^` ~ ,~ ! ~ rv ~ / o ~ BUSINESS ID NUMBER 15-021- Ebpp S Z . n'. 1 YV1 1/~ G ~ / J - Section 1: Business Plan and Inventory Program ~"g (~ ROUTINE ^ COMBINED ^ JO1NT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND IJpr ^ BUSIIIeSS 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 PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ~Q NO EXPLAIN: QUESTIONS REGARDING THIS INSPECTION?/ PLEASE CALL US AT (661) 326-3979 • ~ ~/yyLo / ~. Inspe or (Please Print) Fire Prevention / 1" In /Shift of Site/Station # ~ ~~ - White -Prevention Services Yellow -Station Copy Pink -Business Copy ~~ - - _ - - - FD 2155 {Rev. 09/05 + PLANNED PARENTHOOD MAR MO'NTE ________________________ SiteID: 015-021-000052 + Manager TAMMY RUTLEDGE Location: 2535 16TH ST 100 City BAKERSFIELD BusPhone: (661) 634-1000 Map 123 CommHaz High Grid: 02A FacUnits: 1 AOV: CommCode: BFD STA 01 EPA Numb: SIC Code: DunnBrad:23-711-4083 Emergency Contact / Title Emergency Contact / Title TAMMY RUTLEDGE / CENiTER MANAGER NOELIA GARCIA / CLINIC COORD Business Phone: (661) 63~9l:-1020x Business Phone: (661) 634-1025x 24-Hour Phone (661} 872'-7844x 24-Hour Phone (661) 324-1841x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact SANDI MOHIZ Phone: (559) 488-4932x MailAddr: 633 N VAN NESS AVE State: CA City FRESNO Zip 93728-3476 Owner PLANNED PARENTHOOD MAR MONTE Phone: (408) 287-7532x Address 1691 THE ALAMEDA State: CA City SAN JOSE Zip 95126 Period to TotalASTs: - Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: ~ Emergency Directives: ~ PROG A - HAZMAT ~Ibl~~ H~ ~ ~ ~~~~ Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submi~.ed-end believe the information is true, mate, an complete. ~- C,~~~ Signature -1- 02f28f2006 ~~ '~ • 4~tiy„ F~+Q~ •. CITY OF BAI{ERSFIEI.D FIRE DEPARTMENT b~ OFFICE OF ENVIRC)NMENTAL SERVICES •y~ UNIFIED PROC;RA1~'I INSPECTION CHECKLIST :wR""'Rtip~ 1715 Chester Ave., 3r~ Floor, Bakersfield, CA 93301 FACILITY NAME~~nnc~ ra~~~a~ ADDRESS Z-~..~.5~ ~ f`' s'~- FACILITY CONTACT_ ~n~-~-l ~~,._ INSPECTION TIME dpo 0 INSPECTION DATE /"•-//-~S PHONE NO. 1v.~1~- /d 2a' BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES z ~ Section 1: Business Plan and Inventory Program Routine ^ Combined a Joint Agency ^Minti-Agency [] Complaint ^ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy x Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: d Yes ~No Explain: Questions regarding this inspection? Please call us at (661) 326-3979 White -Env. Svcs. Yellow -Station Copy Pink -Business Copy t~~y~~ ~~'~' ~'~ C 4 ~m .y ti~~ ~,,r FACILITY NAME~pI AllDRESS,~,~~ I ~ FACILITY CONTACT INSPECTION TIME~L CITY OF BAKERSFIEI,D 1'IRF. DEPARTMENT OFFICE OF ENVIRON~IF.NTAL SERVICES pC~f 6 2003 UNIFIED PROGR.~h'1 INSPECTION C.IIECKLIST 1715 Chester Ave., 3"' floor, Bakersfield, CA 93301 ~ ~ cL PGirt/h ~ ~~(, INSPECTION DAT _ 3 ~ ~ 3 f h~ PHONE NO. ~34- y'~ ~w BUS[NE-SS [D NO. 15-2[0- ~J ~ ^~~l_;~•~~,y I a.J . ~ ~ : a..~ NCIMBI~R Of EMPLOYEES Section 1: Business Plan and Inventory Program Routine ^ Combined ^ Joint Agency ^MultI-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 Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: ^ Yes ~No Explain: Questions regarding this inspection? Please call us at (661) 326-3979 ~ Z ~/ S~E~ Q.cc.,~o L~h~ Business Site Responsible Party /'i.-; r Whig -Env. Svcs. Yellow - S181ion Copy Pink -Business Copy Inspector: Gr, ~ ! ~v 4 r. '~ yj; PLANNEb PARENTHOOD MAR MONTE Manager TAMMY RUTLEDGE Location: 2535 16TH ST 100 City BAKERSFIELD CommCode: BFD STA Ol EPA Numb: SiteID: 015-021-000052 BusPhone: (661) 634-1000 Map 123 CommHaz High Grid: 02A FacUnits: 1 AOV: SIC Code: DunnBrad:23-711-4083 Emergency Contact / Title Emergency Contact / Title TAMMY RUTLEDGE / CENTER MANAGER NOELIA GARCIA / CLINIC COORD Business Phone: (661) 634-1020x Business Phone: (661) 634-1025x 24-Hour Phone (661) 872-7844x 24-Hour Phone (661) 324-1841x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact SANDI MOHIZ Phone: (559) 488-4932x MailAddr: 633 N VAN NESS AVE State: CA City FRESNO Zip 93728 -3476 Owner PLANNED PARENTHOOD MAR MONTE Phone: (408) 287-7532x Address 1691 THE ALAMEDA State: CA City SAN JOSE Zip 95126 Period to TotalASTs: = Gal Preparers TotalLTSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT Lased on my inquiry of those individuals ENT'p FE g 2 6 2007 responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information i~ true , acc e, a d complete. '~ ~~~ Signature p -1- 02/06/2007 F PLANNED PARENTHOOD MAR MONTE SiteID: 015-021-000052 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE OXYGEN F P F P IH IH G G 218.00 6792.00 FT3 FT3 Hi Low -2- 02/06/2007 -3- 02/06/2007 F PLANNED PARENTHOOD MAR MONTE ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME NITROUS OXIDE Location within this Facility Unit EXAM ROOM 3 STATE TYPE PRESSURE _ Gas TPure ~-Above Ambient SiteID: 015-021-000052 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 10024-97-2 TEMPERATURE CONTAINER TYPE Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 218.00 FT3 218.00 FT3 178.00 FT3 t1~~~1cL~u5 wrir~lvl,ly 1 °sWt. RS CAS# 100.00 Nitrous Oxide No 10024972 ri1-~GHtCL 1-~J~L' S.71~1L"~1V 1 7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME OXYGEN Location within this Facility Unit WORK STATION STATE TYPE PRESSURE _ Gas TPure -TAbove 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 6792.00 FT3, 6792.00 FT3 6792_.00 __FT3 riLiGtiKLVV~7 LV1~lYV1VL"1V1~ oWt. RS CAS# 100.00 Oxygen, Compressed No 7782447 t1HGijiC.1J L~.'~~JJJ~1~1L'1V1~ TSecret RS BioHaz RadioactivefAmount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -4- 02/06/2007 F PLANNED PARENTHOOD MAR MONTE SiteID: 015-021-000052 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 10/05/2000 CALL 911. 9 Employee Notif./Evacuation 10/14/1992 THE FACILITY MAINTAINS AN EVACUATION PLAN AND DIAGRAM WHICH IS POSTED THROUGHOUT THE FACILITY (REQUIRED BY STATE HEALTH LICENSING). STAFF IS ROUTINELY DRILLED ON EVACUATION PROCEDURES. Public Notif./Evacuation 10/05/2000 EMPLOYEES ARE TRAINED IN EMERGENCY EVACUATION PROCEDURES TO FOLLOW, ASSIST PATIENTS/VISITORS FROM THE BLDG, FOLLOWING POSTED EVACUATION PLANS. Emergency Medical Plan 10/05/2000 STAFF IS TO CALL THE 911 EMERGENCY NUMBER TO SUMMON THE FIRE DEPT/PARAMEDIC TEAM FOR ASSISTANCE. EMERGENCY MEDICAL ASSISTANCE TS ALSO AVAILABLE AT: KERN MEDICAL CENTER, 1830 FLOWER ST, 326-2000. -5- 02/06/2007 F PLANNED PARENTHOOD MAR MONTE SiteID: 015-021-000052 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 07/06/1998 ~ THE OXYGEN IS STORED IN A STANDARD CYLINDER AND IS ROUTINELY CHECKED BY PERSONNEL FOR LEAKS AND LOSS OF PRESSURE. SUPPLY COMPANY REPLACES CYLINDER UPON REQUEST. iCC1CQ.7C l.Vll 1. CL 111l11C111.. 1..1 CCLll V~J V 1.1161 1<G e7VU1l.:C 1'91.. 1..1VQl..1 Vll -6- 02/06/2007 F PLANNED PARENTHOOD MAR MONTE SiteID: 015-021-000052 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ -, ,- .~~c~.iai nac~atu~ Utility Shut-Offs 11/29/2006 A) GAS - NONE B) ELECTRICAL - UTIL W END OF BLDG C) WATER - OUTSIDE FRONT DOOR D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 11/29/2006 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. FIRE HYDRANT - W OF BLDG ON 16TH ST. Building Occupancy Level 02/28/2006 20 EMPLOYEES -7- 02/06/2007 {~ F PLANNED PARENTHOOD MAR MONTE SiteID: 015-021-000052 ~ Fast Format ~ ~ Training _ Overall Site ~ Employee Training' 11/29/2006 ,. - MATERIAL SAFETY DATA SHEETS ON FILE. rayC ~ ric~.u i.vi ru~utc vac nc.LU ivi r u~uic u~c -8- 02/06/200 ~,i PLANNED PARENTHOOD MAR MONTE SiteID: 015-021-000052 Manager TAMMY RUTLEDGE Location: 2535 16TH ST 100 City BAKERSFIELD CommCode: BFD STA Ol EPA Numb: BusPhone: (661) 634-1000 Map : 123 CommHaz High Grid: 02A FacUnits: 1 AOV: SIC Code: DunnBrad:23-711-4083 Emergency Contact / Title Emergency Contact / Title TAMMY RUTLEDGE / CENTER MANAGER -A / CLINIC COORD Business Phone: (661) 634-1020x Business Phone: (661) 63.4-~-0~d-5~ 24-Hour Phone (661) 872-7844x 24-Hour Phone (661) 324--1-8'~'1'~ Pager Phone ( ) - x Pager Phone ( ) x ?~?~?i - to Hazmat Hazards: Fire Press ImmHlth Contact : SANDI MOHIZ Phone: (559) 488-4932x MailAddr: 633 N VAN NESS AVE State: CA City FRESNO Zip 93728-3476 Owner PLANNED PARENTHOOD MAR MONTE Phone: (408) 287-7532x Address 1691 THE ALAMEDA State: CA City SAN JOSE Zip 95126 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif ' d: RSs : No ParcelNo: Emergency Directives: ~N~-® ~~ / PROG A - HAZMAT o~~ Oz~ed on my inquiry of those individu.~is responsible for obtaining the information, I certify under penalty of !aw that I have personally oxamined and am famoliar with the information submitted and believe the information is true , urate, and m ete. Signa ure O~t~ -1- 10/03/2007 F PLANNED PARENTHOOD MAR MONTE ~ Hazmat Inventory ~ MCP+DailyMax Order = SiteID: 015-021-000052 ~ By Facility Unit ~ Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE F P IH G 218.00 FT3 Hi OXYGEN F P IH G 6792.00 FT3 Low -2- 10/03/2007 -3- 10/03/2007 F PLANNED PARENTHOOD MAR MONTE SiteID: 015-021-000052 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME NITROUS OXIDE Days On Site 365 Location within this Facility Unit Map: Grid: - s'-~--`r~.~ rt3v nn CAS # c~ 10024-97-2 STATE T TYPE PRESSURE ~~ TEMPERATURE ~- CONTAINER TYPE ~ ~GaS I Pure Above Ambient I Ambient I PORT. PRESS. CYLINDER I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 218.00 FT3 218.00 FT3 178.00 FT3 ru~~xtcLUUa ~vinrvlvr~lvl~ %Wt. RS CAS# 100.00 Nitrous Oxide No 10024972 t1HGHtCL H. 7.7~.7.7P7~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: 4~T1~t~-,~A~~-0~T- ~ ~ vy~ CAS # 7782-44-7 ~GasATE TPureE ~AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 6792:00 FT3 6792.00 _FT3 6792.00 FT3 rLCac~tucLVV.7 L.V1"lt'V1VA1v1.S %Wt• RS CAS# 100.00 Oxygen, Compressed No 7782447 i"lt]L~tiiCL tii J~L' JJ1.1L~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -4- 10/03/2007 F PLANNED PARENTHOOD MAR MONTE SiteID: 015-021-000052 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 10/05/2000 CALL 911. 9 Employee Notif./Evacuation 10/14/1992 THE FACILITY MAINTAINS AN EVACUATION PLAN AND DIAGRAM WHICH IS POSTED THROUGHOUT THE FACILITY (REQUIRED BY STATE HEALTH LICENSING). STAFF IS ROUTINELY DRILLED ON EVACUATION PROCEDURES. Public Notif./Evacuation 10/05/2000 EMPLOYEES ARE TRAINED IN EMERGENCY EVACUATION PROCEDURES TO FOLLOW, ASSIST PATIENTS/VISITORS FROM THE BLDG, FOLLOWING POSTED EVACUATION PLANS. Emergency Medical Plan 10/05/2000 STAFF IS TO CALL THE 911 EMERGENCY NUMBER TO SUMMON THE FIRE DEPT/PARAMEDIC TEAM FOR ASSISTANCE. EMERGENCY MEDICAL ASSISTANCE IS ALSO AVAILABLE AT: KERN MEDICAL CENTER, 1830 FLOWER ST, 326-2000. -5- 10/03/2007 F PLANNED PARENTHOOD MAR MONTE SiteID: 015-021-000052 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 07/06/1998 ~ THE OXYGEN IS STORED IN A STANDARD CYLINDER AND IS ROUTINELY CHECKED BY PERSONNEL FOR LEAKS AND LOSS OF PRESSURE. SUPPLY COMPANY REPLACES CYLINDER UPON REQUEST. iCC1Cd5C l.Vll l..d 11111LC11L ~.icaii vN Vl.i1CL 1SC.7VULl.:C 1'-1C:l,1Vdl.lVll -6- 10/03/2007 F PLANNED PARENTHOOD MAR MONTE SiteID: 015-021-000052 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~Yec:ldi na~c~ius Utility Shut-Offs GAS - NONE ELECTRICAL - UTIL W END OF BLDG WATER - OUTSIDE FRONT DOOR SPECIAL - NONE LOCK BOX - NO 02/28/2007 Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. FIRE HYDRANT - W OF BLDG ON 16TH ST. 11/29/2006 Building Occupancy Level 20 EMPLOYEES 02/28/2006 -7- 10/03/2007 r ~s F~PLANNED PARENTHOOD MAR MONTE SiteID: 015-021-000052 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 11/29/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. rayC ~ Held for Future Use 11C 11A 1V1 1'UI. UlC Vw7C -8- 10/03/2007