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Home My WebLink AboutBUSINESS PLANi i 1. rl KOH DD5 INC STANLEY S SiteID: 015-021-002295 Manager STELLA KOH Location: 3301 19TH ST B City BAKERSFIELD BusPhone: (661) 327-2051 Map 102 CommHaz High Grid: 26B FacUnits: 1 AOV: CommCode: BFD STA O1 EPA Numb: SIC Code:8021 DunnBrad: Emergency Contact / Title Emergency Contact / Title STANLEY S KOH DDS / OWNER STELLA KOH / MANAGER Business Phone: (661) 327-2051x Business Phone: (661) 327-2051x 24-Hour Phone (661) 327-2051x 24-Hour Phone ( ) - x Pager Phone (661) 327-2051x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact STELLA KOH Phone: (661) 327-2051x MailAddr: 3301 19TH ST B State: CA City BAKERSFIELD Zip 93301 Owner STANLEY S KOH DDS Phone: (661) 327-2051x Address 3301 19TH ST B State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT E ~~ ~ ased on my inr.!iry of those individuals `" responsibie for obt~~inir~g tt,e information, I certify under penalty of lacy that - have personai{y examined and am famiiiar with the information submitted and k}eiieve the information is true, accurate, and complete. ,p Signature ~ ®ate -1- 07/12/2007 r^ P KOH DDS INC STANLEY S SiteID: 015-021-002295 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE OXYGEN F P F IH IH DH G G 500.00 500.00 FT3 FT3 Hi Low -2- 07/12/2007 -3- 07/12/2007 F KOH DDS INC STANLEY S ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME NITROUS OXIDE Location within this Facility Unit REAR OFFICE STATE TYPE Gas Pure = PRESSURE _ Above Ambient 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 Daily Average 249.00 FT3 500.00 FT3 500.00 FT3 - r1t~Gt~tcl~VU~ ~V1nrVlv~lvl~ ~Wt. RS CAS# 100.00 Nitrous Oxide No 10024972 til-~GHtCL A.7 a ~ ~ 51~lJly 1 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 REAR OFFICE STATE TYPE PRESSURE _ Gas TPure ~-Above Ambient Facility Unit: Fixed Containers at 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 I Daily Average 249.00 FT3 500.00 FT3 500.00 FT3 I1HGE~.CCLVU.7 1..V1~lYV1VL"1V 1.7 owt. RS CAS# 100.00 Oxygen, Compressed No 7782447 riL~GEitCL Ii~.7~.7~J1~11:,1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low SiteID: 015-021-002295 ~ Facility Unit: Fixed Containers at Site ~ -4- 07/12/2007 F KOH DDS INC STANLEY S SiteID: 015-021-002295 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification Employee Notif./Evacuation tUlJl ll: lVV l.11 / L~VdC:Udl.l Vil P~lllCl_yCilC:y 1~1CU1Ud1 Y1di1 -5- 07/12/2007 F KOH DDS INC STANLEY S SitelD: 015-021-002295 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ tCCLCdSC rLCVCilI.LVil Release Containment ~.icall Vr V1.11CL 1CC~V UL I:C riLI.LVdl.l Vll -6- 07/12/2007 :• - , . :• F KOH DDS INC STANLEY S SiteID: 015-021-002295 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ w7~CC:1d1 rid'Gd.LC.lS Utility Shut-Offs 01/27/2006 ,. r iic riv~.ctr . ~ e-avai.L . vva~.ct Building Occupancy Level -7- 07/12/2007 F KOH DDS INC STANLEY S SiteID: 015-021-002295 Fast Format ~ Training Overall Site ~ Employee Training ruyc ~ nciu ivi rut,ul.c ~~c Held for Future Use 9 -8- 07/12/2007 > ;. }~ ~, = KOH~ DDS INC STANLEY S ~3~ ~" Manager STELLA," ~,j (~ Location: 3301 19TH ST B City BAKERSFIELD CommCode: BFD STA Ol EPA Numb: SiteID: 015-021-002295 BusPhone: (661) 327-2051 Map 102 CommHaz High Grid: 26B FacUnits: 1 AOV: SIC Code:8021 DunnBrad: Emergency Contact / Title Emergency Contact / Title STANLEY S KOH DDS / `f7W n-P~r SHELLY LITTLE / STAFF Business Phone: (661) 327-2051x Business Phone: (661) 327-2051x _ 2 4 -Hour Phone _(6 6 ~) 32~ -2051 x 2 4 -Hour Phone ( ) - x Pager Phone (661) 3z`I - ZOS~x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact !~ 1(a ~c~~1 Phone: (661) 327-2051x MailAddr: 3301 19TH ST B State: CA City BAKERSFIELD Zip 93301 Owner STANLEY S KOH DDS Phone: (661) 327-2051x Address 3301 19TH ST B State: CA City BAKERSFIELD ~ Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: .Emergency Directives: PROG A - HAZMAT ,, n ~~ ~~ ~N~~ ,~~~ ® 1 Based on my inquiry of thaw indivir~ue~is ~®~~ responsible for obtaining the information, !certify under penalty afi law that f have personally examined and am fiamiliar with the information submitted and believe the information is true, accurate, and complete. ~!c~rf %~L~~G"C%"_ _ _ ~~~.S~a 5ignariire vate -1- 05/22/2007 F KOH DDS INC STANLEY S SiteID: 015-021-002295 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE OXYGEN F P F IH IH DH G G 500.00 500.00 FT3 FT3 Hi Low -2- 05/22/2007 -3- 05/22/2007 F KOH DDS INC STANLEY S ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME NITROUS OXIDE Location within this Facility Unit REAR OFFICE STATE TYPE PRESSURE Gas TPure -Above Ambient SiteID: 015-021-002295 ~ Facility Unit: Fixed Containers at 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 Daily Average 249.00 FT3 500.00 FT3 500.00 FT3 t1AGL-1K1JVU~ 1.V1~lYV1V~1V 1_ ~ -- %Wt. ~ RS CAS# 100.00 Nitrous Oxide No 10024972 r~~tjtcl~ tiaa>Jaaln~iv l a 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 REAR OFFICE STATE TYPE PRESSURE Gas TPure Above Ambient Facility Unit: Fixed Containers at 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 249.00 FT3 500:00 FT3 500.00 FT3 I11-1GLitCJJVU~ I.VL~lYV1VL'1V1~ oWt. RS CAS# 100.00 Oxygen, Compressed No 7782447 ri!•iGL•i.tC1J 1-~.7.7J;bbL~1J;1V l w7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -4- 05/22/2007 F KOH DDS INC STANLEY S SiteID: 015-021-002295 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification Employee Notif./Evacuation _ _ Public Notif./Evacuation Emergency Medical Plan r -5- 05/22/2007 0 F KOH DDS INC STANLEY S SiteID: 015-021-002295 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention _ _Release _Containment _ _ _ _ __ ~ _ _ __ _ ._ _._ __ vL.11Gt 1CC5VULl:c LiC:l.lVdl.lVll 0 -6- 05/22/2007 F KOH DDS INC STANLEY S SitelD: 015-021-002295 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ aNc~ial. nac~al.u~ Utility_ Shut-Offs _ ~_` _ _____ __ _`M_ _ _.__ ~ 0.1./_2.7_/2006_ r lip rl_v~CC:. ~ t-wall . wci~er DU1.J.U111y v~:~uNailc:y LCVC1 -7- 05/22/2007 F KOH DDS INC STANLEY S SitelD: 015-021-002295 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training Pane 2 raciu ivi r ut.utc vac Held for Future Use -8- 05/22/2007 Prevention Services UNIFIED PROGRAM, INSPECTION- CH-ECKLIST ' B e R s F , 0 90o Truxtun Ave., Suite 210 _ --- e-_..= _ -~-~ - ~ ---- - _~_-~:~- -,_ FIRE-- --- Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program "R'M T Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME tR ~ DW ~ - - INSPE!/I 7oDA~~ INSPECTI~~ME 3 ADDRESS ~ ~ ( ~ ~~ 0 ~ ~ ~ PH~~~ O. ~ S~ J NO OF EM~OYEES GVt FACILITY CONTACT ~~~~ ~ ~~ BUSINESS ID NUMBER 15-021- Ob2Z-~'~ . ~ ~ ~ Section 1: Business Plan a_nd lr~ver,tory- Program ~ (` ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION nl \ C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIII@SS PLAN CONTACT INFORMATION ACCURATE N 1 D I.J E ^ VISIBLE ADDRESS ~' ^ CORRECT OCCUPANCY 1Q ^ VERIFICATION OF INVENTORY MATERIALS / ~ ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY fX ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ,~ ^ HOUSEKEEPING fd ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT X661 } 326-3979 ~~~ S~~w ~ ~. ~ Inspector (Please Pri ) Fire Prevention / 1s' In !Shift of Site/Station # Busin ite / esponsi le P y (Please Print) ^ YES ~NO White -Prevention Services Yellow -Station Copy Pink -Business Copy ~ ~ - FD 2155 (Rev. 09/05