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Home My WebLink AboutBUSINESS PLAN 7/18/2007~~ L } H C ~ } Q N. •~ ~ I ~ NI I ~I t~ N I~ ;~ :, SAN DIMAS FAMILY DENTISTRY SiteID: 015-021-000020 Manager KATHRYN COVEY Location: 602 34TH ST City BAKERSFIELD BusPhone: (661) 323-2929 Map 103 CommHaz Minimal Grid: 19D FacUnits: 1 AOV: CommCode: BFD STA 04 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title MANSOOR GILANI DDS / DENTIST KATHRYN COVEY / OFFICE MANAGER Business Phone: (661) 323-2929x Business Phone: (661) 323-2929x 24-Hour Phone (661) 323-2929x 24-Hour Phone (661) 323-2929x Pager Phone (661) 863-1311x, Pager Phone (661) 833-3546x Hazmat Hazards: React Contact MANSOOR M GILANI Phone: (661) 323-2929x MailAddr: 602 34TH ST State: CA City BAKERSFIELD Zip 93301 Owner MANSOOR M GILANI DDS Phone: (661) 323-2929x Address 602 34TH ST State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~PROG H - HAZ WASTE GEN Salad on my inquire of those indivsduals responsible for ofraining the infnrr~ation, i certify under psnal'y o~ i~~i, that I have personally examined and am familiar 11~ith the infiormation submitted and u~:{ieye the information is true ~~~ara_~, and ~~mplete. , '~ o.~--• Sigr ature ~ '~ Date ( d ~p J U L ~. 9 2007 -1- 0~/16/200~ _ -;% _ ~ Y F SAN DIMAS FAMILY DENTISTRY SiteID: 015-021-000020 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE FIXER R L 2.00 GAL Min -2- 07/16/2007 -3- 07/16/2007 l F SAN DIMAS FAMILY DENTISTRY SiteID: 015-021-000020 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: DARKROOM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TWaste -~mbient ~ Ambient ~LASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 2.00 GAL 2.00 GAL 2.00 GAL riHGL-1KLVU5 C:VNIYVIVJJIV"1'S ~Wt. RS CAS# Silver No 7440224 riHGl-1K1J A~aJ:;~~1~1J;1V'1'S TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 07/16/2007 r- F SAN DIMAS FAMILY DENTISTRY SiteID: 015-021-000020 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ 1-~C,j.~i1C:~/ 1VV1.111C:CLl.1Ui1 Employee Notif./Evacuation 12/12/1991 NON-TOXIC GAS TO BE RELEASED INTO THE AIR. _,_ , ,~ tUJ/111. 1VV 1.11. • ~ ~+VQI-.UQl.. 1 tJ11 Emergency Medical Plan 05/22/2006 DETERMINE THE EXTENT OF THE EMERGENCY. CALL THE APPROPRIATE AUTHORITIES FOR THE EMERGENCY 911. ASSIST THE INJURED PERSON BY CPR, FIRST AID, OR SHOCK. WAIT FOR MEDICAL HELP TO ARRIVE. -5- 07/16/2007 F SAN DIMAS FAMILY DENTISTRY SitelD: 015-021-000020 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/22/2006 ~ NITROUS OXIDE AND OXYGEN ARE CHAINED TO THE WALL. VOICE COMMUNICATION TO EVACUATE THE PREMISES. Release Containment Clean Up CALL JIM WARREN FOR SMALL SPILLS. CALL 911 FOR LARGER SPILLS. 03/08/2007 Vl.i1Cl icesc~urce AcL1vaLlon -6- 07/16/2007 F SAN DIMAS FAMILY DENTISTRY SitelD: 015-021-000020 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .7~JCl:1 Gil 1701 L. G1.i l.iT7." Utility Shut-Offs 03/08/2007 GAS - SE CRNR OF BLDG ELECTRICAL - REAR DOOR N SIDE OF BLDG WATER - SE CRNR OF BLDG Fire Protec./Avail. Water BAKERSFIELD FIRE DEPT, CALL 911. 03/08/2007 Building Occupancy Level 03/08/2007 49 PEOPLE -7- 07/16/2007 r i; ,•, F SAN DIMAS FAMILY DENTISTRY SiteID: 015-021-000020 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 03/08/2007 ~ BRIEF SUMMARY OF TRAINING PROGRAM: PROVIDED BY JIM WARREN. ruyC ~ Held for Future Use ~~~. ~~ UNIFIED PROGRAM INSPECTION CHECKLIST ~~' .c:+:/~t..::wxcP:*:rr',r'ar~+.:: ~xr;~,.fc<s+. ,,.::-s~. ,. s~. ...~.,~ ,..i ~:o _•,ao . ........... ...:::. .. :. ~. z:. :. SECTION 1: Business Plan and Inventory Program y BARERSFIELD FIRE DEPT Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME NSPE TION D TE NSPECTION TIME !1-'~~ SA frV ~ 1 +M,~S M i t-. 4.JrC. ,v~°%~~R~ i ~ ~ ~~ ADDRESS ~-(„ HONE NO. O OF EMPLOYEES 6U2 3 ~ ,S} FACILITY CONTACT ~ USINESS ID NUMBER 15.021- a Section 1: Business Plan and Inventory Program ^ ROUTINE ,~ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY '^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Vblation COMMENTS - - - ----~-- ^ ~ APPROPRIATE PERMIT ON HAND ((~~ fP t e C)l Cv t, f ,~,,,-~ ~~ c ~~--~ ,t YJ ^ BUSIr1ASS 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 8 ON HAND ' i ANY HAZARDOUS WASTE ON SITES ~ES ^ NO EXPLAIN: _ ~ C' S ~ E _-'~s E G7 - ---...._,_ _..------.. QUESTIONS REGARDING THIS INSPECTION4 PLEASE CALL US AT (881) 928-3879 ~~~~~ ~~~ Inspector (Please Print) Fire Prevention / In / Shift of Ske/Station k Business Site/Sc Site Res iWe Pa Please Print) White -Prevention Services Yellow - Ste6on Copy Pink - Buaineae Copy FD20ss (Rev. 02/t15) ~rir~ ~~rr ~4 ~ T~° CITY OF BAKERSFIELD FIRE DEPARTMENT °~~ OFFICE OF ENVIRONMENTAL SERVICES • • ~~ UNIFIED PROGRAM INSPECTION CHECKLIST ~"~gti,~ 1715 Chester Ave., 3~d Floor, Bakersfield, CA 93301 FACILITY NAMES~N -(~~ ~- ~s ~~. ~ ~ T •11~~` i~S i ~~ INSPECTION DATE 3 ~ 8 r G Section 4: Hazardous Waste Generator Program EPA ID # ~~`~ r''` ~ r ^ Routine ~ Combined ^ Joint Agency ^Multf-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number - ~x ~ r,-. p 7-' Authorized for waste treatment and/or s, forage Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line A~ ~q Secondary containment provided Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste N Proper management of lead acid batteries including labels 9~ Proper management of used oil filters ~ Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years ~~,~ • fj ~ ~ ~ Retains hazardous waste analysis for 3 years ~,, „ ~ , *,~ Q r Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal L=c:omp-iance ~V=violation Inspector: ~ 7G- 2J~ t ~-~ ~~ Office of Environmental Services (661) 326-3979 White -Env. Svcs. Busin s Site Resp arty Pink -Business Copy ~~. -. SAN DIMAS FAMILY DENTISTRY = ~~,~~ i _ _ Manager ~~(,~~i~~i41 ~V~ Location: 602 34T ST City BAKERSFIELD CommCode: BFD STA 04 EPA Numb: BusPhone: Map 103 Grid: 19D SIC Code: DunnBrad: ~i~ SiteID: 015-021-000020 (661) 323-2929 CommHaz Minimal FacUnits: 1 AOV: Emergency Contact / .~ Title Emergency Contact / Title MANSOOR G _ ILANI DDS / O'Lt~~~s~ KATHRYN COVEY / OFFICE MGR Business _ Phone: (661) 323-2929x Business Phone: (661) 323-2929x 24-Hour Phone (661) 323-2929x 24-Hour Phone (661) 323-2929x Pager Phone (661) 863-1311x Pager Phone (661) 833-3546x Hazmat Hazards: React Contact MANSOOR M GILANI DDS Phone: (661) 323-2929x MailAddr: 602 34TH ST State: CA City BAKERSFIELD Zip 93301 Owner MANSOOR M GILANI DDS Phone: (661) 323-2929x Address 602 34TH ST State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN EN~p MAR 8 X007 3ased on my inquiry of thane indivi~~raais responsi~ie far oataining the information, !certify under penal#y of law that I have personally examined and am familiar with the information submitted and believe the information is true , accur~ ~e, and complete. Signature ~ , Date -1- 02/06/2007 F SAN DIMAS FAMILY DENTISTRY SiteID: 015-021-000020 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... ISpecHazIEPA Hazards) Frm I DailyMax IUnitIMCPI WASTE FIXER R L 2.00 GAL Minl -2- 02/06/2007 _3_ 02/06/2007 F SAN DIMAS FAMILY DENTISTRY SiteID: 015-021-000020 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: DARKROOM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TWaste -~ Ambient ~ Ambient -~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 2.00 GAL 2.00 GAL 2.00 GAL HAZARDOUS COMPONENTS ~Wt. RS CAS# Silver No 7440224 riHGAK.IJ A~~L' J~1~11~1V 1"J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 02/06/2007 F SAN DIMAS FAMILY DENTISTRY SiteID.: 015-021-000020 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ r~ycll~y 1VV1.1111:cL1.1V11 Employee Notif./Evacuation NON-TOXIC GAS TO BE RELEASED INTO THE AIR. 12/12/1991 t LLi.JllV lVV Vlt~L'V0.1..U0.V1V11 Emergency Medical Plan 05/22/2006 DETERMINE THE EXTENT OF THE EMERGENCY. CALL THE APPROPRIATE AUTHORITIES FOR THE EMERGENCY 911. ASSIST THE INJURED PERSON BY CPR, FIRST AID, OR SHOCK. WAIT FOR MEDICAL HELP TO ARRIVE. -5- 02/06/2007 F SAN DIMAS FAMILY DENTISTRY SiteID: 015-021-000020 ~ _ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/22/2006 ~ NITROUS OXIDE AND OXYGEN ARE CHAINED TO THE WALL. VOICE COMMUNICATION TO EVACUATE THE PREMISES. Release Containment Cleaiz Up -- ~ , L ,o,n..c ~. go,. ~/~ Ca // ~ /~ Other Resource Activation -6- 02/06/2007 F SAN DIMAS FAMILY DENTISTRY SiteID: 015-021-000020 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .~~c~.l.ai nac~aiuo Utility Shut-Offs A) GAS - SE CRNR OF BLDG B) ELECTRICAL - REAR DOOR N SIDE OF BLDG C) WATER - SE CRNR OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO 05/22/2006 Fire Protec./Avail. Water ~a• ~E ~s -E', e 1 ~ ~ ~ ~G <Building Occupancy Level -7- 02/06/2007 r> ~ F SAN DIMAS FAMILY DENTISTRY SiteID: 015-021-000020 ~ Fast Format ~ ~~Training Overall Site ~ Employee Training ~ ~~ ~ - rayc ~ nc~.u iuL ru~uic vac ncl.u iui r uLUre use -8- 02/06/2007 :~ + SAN DIMAS FAMILY DENTISTRY __________________________ SiteID: 015-021-000020 + Manager BusPhone: (661) 323-2929 Location: 602 34TH ST Map 103 CommHaz Minimal City BAKERSFIELD Grid: 19D FacUnits: 1 AOV: CommCode: BFD STA 04 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title ~ Emergency Contact / Title MANSOOR GILANI DDS / KATHRYN COVEY / OFFICE MGR Business Phone: (661) 329-2929x Business Phone: (661) 329-2929x 24-Hour Phone (661) 329-2929x 24-Hour Phone ( - Pager Phone (fir, > gio3 -13t i x ( ~nl;~l ) 833=;~54(~x Hazmat Hazards: Reac t Contact MANSOOR M GILANI DDS Phone: (661) 323-2929x MailAddr: 602 34TH ST State: CA City BAKERSFIELD Zip 93301 Owner MANSOOR M GILANI DDS Phone: (661) 323-2929x Address 602 34TH ST State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN n ,~ ~~' I ~5 o~$ ~'~ 1 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 submitted and believe the information is true, ac urate, and complete. i Sign lure Date Cl~ll~ / ,A / ' (/ /v' V ~ Z~~6 t______________________________________________________________________________+ -1- 05/22/2006