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HomeMy WebLinkAboutBUSINESS PLAN® ~ - ~>. ~ ~ ~- a ~- ~ ., A W 'W W' O ~' x ~~ `o~ : i ~ '~ `t j ~ ~ -r M i to ~n f ---~ ~~~ ~ I ~ m U _F _ ', UNIFIED PROGRAM INSPECTION CHECKLISTS Prevention Services B E a s F, D .900 Truxtun Ave., Suite 210 ___ ~_~--- =-~.~~ - __ __ ~ _.. ~. ==-=_-= = -=- = ~ _~.= _ ~ ` FIRE _ Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program ! ""'"' r Tel.: (661) 326-3979 ~~ ~ Fax: (661) 872-2171 FACILITY NAME INSPECTION DATE INSPECTION TIME ADDRESS ~~~ ~~t~ sr PHONE NO ~~_~'~~© NO OF EMPLOYEES FACILITY CONTACT -/ ~ f ~i~i!' ~L !`~ 1Ci''r~.~'//~~~ BUSINESS ID NUMBER 15-021- C1S'~~fr :~ Section 1: Business Flan and. Inventory,Program ROUTINE ^ COMBINED ^ JOINT AGENCY. ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS B~ ^ APPROPRIATE PERMIT ON HAND @~ ^ BUSIfII?SS PLAN CONTACT INFORMATION ACCURATE 0~ ^ VISIBLE ADDRESS ®' ^ CORRECT~OCCUPANCY ^ ^ VERIFICATION OF INVENTORY MATERIALS ~0 ~Dir/6~~n C,~ t%/~l O ^ ^ VERIFICATION OF QUANTITIES ~ © ~ d f GI ,Y J ^ ^ VERIFICATION OF LOCATION ^ ^ PROPER SEGREGATION OF MATERIAL ^ ^ VERIFICATION OF MSDS AVAILABILITY ^ ^ VERIFICATION OF HAZ MAT TRAINING N 0 4 2OO/ ^ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND KBr-6013 ANY HAZ.IA~RDOUS WASTE ON SITE? ^ YES ^ NO EXPLAIN: ^ ~B LO/~~~I~ /~ f~/~~ - ~~~ ~i~I$~ QUESTIONS REGARDING THIS SP TION? PLEASE CALL US AT (661) 326-3979 ,~~ .~~ ~- Inspector (Please Print) Fire Prevention / 1s` In /Shift of Site/Station # Business Site /Responsible Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 '~ `~ M$DI STOP HOME MEDICAL SUPPLY Manager ~ ~a. ~ u e L f~e,r,ri ~ ~. ~ e z Location: 815 34TH ST City BAKERSFIELD CommCode: BFD STA 04 EPA Numb: BusPhone: (661) 328-9920 Map 103 CommHaz Low Grid: 19D FacUnits: 1 AOV: SIC Code:7352 DunnBrad: Emergency Contact / Title Emergency Contact / Title MANUEL HERNANDEZ / CORP PRES NANCY JACQUES / CORP SECRETARY Business Phone: (661) 328-9920x Business Phone: (661) 328-9920x 24-Hour Phone (661) 978-5560x 24-Hour Phone (661) 326-1674x Pager Phone (661) 329-7239x Pager Phone (661) 978-5562x Hazmat Hazards: Fire Press ImmHlth Contact : TTTTTrV T„~,„r,n~ /~/fa,,.~v2L H2~'s~lo.~n ~'Z. phone: (661} 328-9920x MailAddr: 815 34TH ST State: CA City BAKERSFIELD Zip 93301 Owner MEDI STOP HOME MEDICAL SUPPLIER Phone: (661) 328-9920x Address PO BOX 40547 State: CA City BAKERSFIELD .Zip 93384-1120 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No _ ParcelNo: Emergency irectives: PROG - HAZMAT ENT'D MAY 16 2007 f3aved 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, accurate, and complete. S ~~~©~ Date Signature ~! °~` ~~"z.. C ~ 7 • A~~n ~ c~- ~~~~ SiteID: 015-021-000262 -1- 02/05/2007 F MEDI STOP HOME MEDICAL SUPPLY ~ Hazmat Inventory ~ MCP+DailyMax Order = SiteID: 015-021-000262 ~ By Facility Unit ~ Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP MEDICAL OXYGEN F P IH G 4880.00 FT3 Low Nf ~~ e ~ ~~-{ ~- S A~P~P DX rye "~ ~ ,,,,, o ~- ~ , ~~~ . ~r s ~~~~ -2- 02/05/2007 -3- 02/05/2007 F MEDI STOP HOME MEDICAL SUPPLY SiteID: 015-021-000262 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME MEDICAL OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: OUTSIDE SW REAR CAS# 7782-44-7 STATE T TYPE PRESSURE TEMPERATURE CONTAINER TYPE ~GaS i Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Co300100rFT3 Daily4880100m FT3 I Daily3660r00e FT3 riHGL-1tCLVUS 1.:111~1r~1v1'~lvl~ °sWt . RS CAS# 100.00 Oxygen, Compressed No 7782447 riHGHl[L L~J SL'~~S1~1L;1V 1'7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low ~ ~~~~ -4- 02/05/2007 F`MEDI STOP HOME MEDICAL SUPPLY SiteID: 015-021-000262 ~ Fast Format ~ ~ Notif./EvacuationjMedical Overall Site ~ ~ Agency Notification 05/01/2001 ~ CALL 911, TRY TO EXTINGUISH FIRE, EVACUATE PROCDURES, MEDICAL EMERGENCY NUMBERS. Employee Notif./Evacuation 05/01/2001 EVACUATE PERSONNEL AND NEIGHBORING BUSINESSES AND CALL 911. (r~ Public Notif./Eva~ation EXIT SIGNS INSID OF TORE BLDG AREA. 05/01/2001 WARNING SIGN OUTSIDE BY OXYGEN TANK Emergency Medical Plan 05/01/2001 MERCY HOSPITAL, 2215 TRUXTUN AVE, 327-3371 OR MEMORIAL HOSPITAL, 420 34TH ST, 327-1792 OR SAN JOAQUIN HOSPITAL, 2615 EYE ST, 327-1711. -5- 02/05/2007 F MEDI STOP HOME MEDICAL SUPPLY SiteID: 015-021-000262 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/01/2001 ~ AIR OUT AND OXYGEN TANKS ARE CHAINED AND ARE LOCKED IN AN OPEN AIR AREA. Release Containment NONE., APPROVED PORTABLE PRESSURIZE CYLINDERS. ~~ s ` /~~ ~~ ~/ Clean Up N/A. (~ ~V X k~ 05/01/2001 05/01/2001 Other Resource Activation -6- 02/05/2007 ,2_ F~MEDI_STOP HOME MEDICAL SUPPLY SiteID: 015-021-,000262 ~ Fast. Format ~ ~ Site Emergency Factors Overall Site ~ aNc~iai nac,aiu~ = Utility Shut-Offs A) GAS - W SIDE OF BLDG BEH FENCE FRO T OF BLDG B) ELECTRICAL - INSIDE BLDG L OF SE CK DOOR C) WATER - OUTSIDE SE BACK DOOR ~ ~~ D) SPECIAL NONE G~~ E) LOCK BOX - NO i ~` V/ 12/29/2006 Fire Protec./Avail. Wat~ ~~ PRIVATE FIRE PROTECTIO - IRE E T UISHERS (HALON 1211). FIRE HYDRANT - 820 3 S (MERC EDICAL CENTER). 12/29/2006 Building Occupancy Level 03/01/2006 10 EMPLOYEES -7- 02/05/2007 .~ M. i~ F MEDI STOP HOME MEDICAL SUPPLY SiteID: 015-021-000262 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 12/29/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUNIMARY OF TRAINING PROGRAM: METHODS FOR HANDLING OF HAZARDOUS MATERIAL; COORDINATE ACTIVITIES WITH RESPONSE AGENCIES; PROPER USE OF SAFETY EQUIPMENT; EMERGENCY EVACUATION PROCEDURE. yo .1 J t.__ 11C 11A 14J1 1' V.1..U1G Val. C -8- 02/05/2007 UNIFIE® PROGRAM INSPECTION CHECKLIST SECTION 1 Business .Plan and Inventory Program • FACILITY NAME ~ ~ J ~~i11 ~ ~ INSPECTION DATrE INSPECTION TIME . ._-. _ _._. _. - ---- ADDRESS ,,._ ~ ~ c a ~ _ ~ s ~~ PHONE No. z~`-~~~ No. of Employees ~ __ _ .- _ _ ----- ---------- - ---- ----- _ _ __--___ -- FACILITYCONTACT .. -- .._ _ _ -.--- -- _ _ _ - _ -- - liusmess ID umber --- _- _ - ---- Section 1: Business Plan and Inventory Program Routine O Combined O Joint Agency OMulti-Agency O Complaint O Re-inspection Bakersfield 1~ire Dept. ' Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel: (661)_326-3979 _ __ ANY HAZARDOUS WASTE ON SITE?: ^ YES ~ NO EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CAL-L~•U~jS AT ~66') ~ 326-3979 Inspector (Please Print) Fire Prevention 1st-In/Shift of Site Business Site Responsible Party (Please Print) ~ Pink • Business Copy White • Environmental Services Yellow -Station Copy + MEDI STOP HOME MEDICAL SUPPLY _______________________ SiteID: 015-021-000262 + Manager BusPhone: (661) 328-9920 Location: 815 34TH ST Map 103 CommHaz Low City BAKERSFIELD Grid: 19D FacUnits: 1 AOV: CommCode: BFD 5TA 04 SIC Code:7352 EPA Numb: DunnBrad: t______________________________________________________________________________+ Emergency Contact / Title Emergency Contact / Title MANUEL HERNANDEZ / CORP FRES NANCY JACQUES / CORP SECRETARY Business Phone: (661) 328-9920x Business Phone: (661) 328-9920x 24-Hour Phone (661) 978-5560x 24-Hour Phone (661) 326-1674x Pager Phone (661) 329-7239x Pager Phone (661) 978-5562x Hazmat Hazards: Fire Press ImmHlth Contact Phone: (661) 328-9920x MailAddr: 815 34TH ST State: CA City BAKERSFIELD Zip 93301 Owner MEDI STOP HOME MEDICAL SUPPLIER Phone: (661) 328-9920x Address PO BOX 40547 State: CA City BAKERSFIELD Zip 93384-1120_ Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ~~ BAR 15 2006 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, accurate, and com lete. .. ~-~-off Signature Date -1- 03/03/2006 /~ i~i4~ELD p~~ ~`~ Vey ~ CITY OF BAICERSFIEI.D FIRE DEPARTMENT ~ ~ OFFICE OF ENVIRONMENTAL SERVICES F ~ '~ ~ `,'" ~' ~ ~ UNIFIED PROGRAl~1 INSPECTION CHECKLIST ,~,~.~ ~,~~~,,~' 1715 Chester Ave., 3'd Floor, Bakersfield, CA 93301 Y 1 FACILITY NAME II'~ C ,J ~ `~ 513 ADDRESS SI S 3 `~ TI-~- FACILITY CONTACT INSPECTION TIME t S /h t n~ INSPECTION DATE ~ ^-~ ^ ~ 3 _ PHONE NO. BUSINESS ID NO. I5-210- z- 6 L NUMBER OF EMPLOYEES 13 Section 1: Business Plan and Inventory Program Routine ^ 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 Naz 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 White -Env. Svcs. Yellow -Station Copy Pink -Business Copy 1 Business Site Responsible Party Inspector: l~-Q~i~l~~ X13 ~~~__..-