The URL can be used to link to this page

Home My WebLink AboutBUSINESS PLAN 7/18/2007_l --~ Q'. i~~ l Q Q _-` -°~ ~~ ~-a ~~Q ''l.cc~ ~ '~ I~ ((!! ~ u_J L.' . ~ LAM DDS ROLLAND H BusPhone: Map 123 Grid: 02C SiteID: 015-021-002454 Manager MISTI RODRIGUEZ Location: 4698 AMERICAN AVE A City BAKERSFIELD CommCode: BFD STA 07 EPA Numb: SIC Code: DunnBrad: (661) 834-0911 CommHaz Minimal FacUnits: 1 AOV: Emergency Contact / Title Emergency Contact / Title ROLLAND H LAM DDS / / Business Phone: (661) 834-0911x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact MISTI RODRIGUEZ Phone: (661) 834-0911x MailAddr: 4698 AMERICAN AVE A State: CA City BAKERSFIELD Zip 93309 Owner ROLLAND H LAM DDS Phone: (661) 834-0911x Address 4698 AMERICAN AVE A State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ~N' u JU~ ~ ~ ~n q ~/ OasFd on my inquiry of those individuals , the intcrmatio i ' e ng re fur ctrtarn rsonally responsCc of Ia~J that I have p lt y under pena examined and am fa.rniliar ~^!~th the inforration the information is true, subm~ d camplete te, and r Date Signature -1- 07/12/2007 [. 1 F LAM DDS ROLLAND H SiteID: 015-021-002454 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards) Frm DailyMax IUnitIMCPI WASTE FIXER R L 5.00 GAL Minl -2- 07/12/2007 -3- o~/ia/aoo~ F LAM DDS ROLLAND H ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME WASTE FIXER Location within this Facility Unit DARKROOM SiteID: 015-021-002454 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# Liquid TWaste ~mbient~E ~ AmbientT~E -~STOICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 5.00 GAL 5.00 GAL 5.00 GAL ru~~tirxLUUS ~urirviv~iv'1 gWt. RS CAS# Silver No 7440224 riAGAKL AJ7~~J1~1t;1V'1_a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 07/12/2007 a F LAM DDS ROLLAND H SiteID: 015-021-002454 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ 1-~yvll~y 1VV1.111C:d1.1V11 i -.. r~u~Nivycc 1vVtril.. ~ P.~VdI.:Udl.1V11 _i_ ~ i.-. r uu11~. ivV l.1L ~ I.+V0.l:Udl.1 V11 r~uiciycll~y 1'1CU1C:d1 Y1d11 -5- 07/12/2007 e F F LAM DDS ROLLAND H SiteID: 015-021-002454 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention - 1ZG1GdAC t.Vll 1. d.l llLlLC11L n7 V1GGill Vt.J V l.S1C 1_ 1<C.7"VUl. C.:C Hl: l,lVdl.l Vil -6- 07/12/2007 F LAM DDS ROLLAND H SiteID: 015-021-002454 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ otJG x..10.1 nac~aiu~ Utility Shut-Offs ,_ riic riv~.c~:.~r~vca~i. wa~.ci. Building Occupancy Level -7- 07/12/2007 F LAM DDS ROLLAND H SiteID: 015-021-002454 ~ Fast Format ~ ~ Training Overall Site ~ _, ui~iZ/ivycc 11a111111tJ. rays ~ nciu 1.v.L ru~uic u5C nC1u luL r UI.UiC U~~ -8- 07/12j2007 i 1 a °,. , E: LAM DDS ROLLAND H 359 Manager ; ~v1,~1~ ~ ~ ~.r~ ~v3 ! Location: 4698 AMERICAN AVE A City BAKERSFIELD CommCode: BFD STA 07 EPA Numb: BusPhone: Map 123 Grid: 02C SIC Code: DunnBrad: SiteID: 015-021-002454 (661) 834-0911 CommHaz Minimal FacUnits: 1 AOV: Emergency Contact / Title Emergency Contact / Title ROLLAND H LAM DDS / / Business Phone: (661) 834-0911x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact i`,~ ~i:Lj7 ,~ Phone: (661) 834-0911x MailAddr: 4698 AMERICAN V~ State: CA City BAKERSFIELD Zip 93309 Owner ROLLAND H LAM DDS Phone: (661) 834-0911x Address 4698 AMERICAN AVE A State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: d I PROG H - HAZ WASTE GEN ~~ ~ a ~Nr~D a ~ R ~ s zoos i3ased 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, rate, and complete. /s'._~7 ignature Date -1- 02/02/2007 _-; F LAM DDS ROLLAND H SiteID: 015-021-002454 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE FIXER R L 5.00 GAL Min -2- 02/02/2007 _-- -3- 02/02/2007 '7' F LAM DDS ROLLAND H SiteID: 015-021-002454 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: DARKROOM CAS# Liquid TWaste -~mbient~E ~ AmbientT~E ~ PLASTCICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL • HAZARDOUS COMPONENTS %Wt. RS CAS# Silver No 7440224 I1HGtii[L H~ 7~JL~.7.71~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 02/02/2007 F LAM DDS ROLLAND H SiteID: 015-021-002454 Fast Format ~ Notif-.-/-Evacuation/Medical Overall Site ~ Agency Notification Employee Notif./Evacuation = r'~.I.IAJ l 1 V lY V 1. I t / L' V 0.t. t,LG1 l.1 V 11 'Emergency Medical_Plan -5- 02/02/2007 F'LAM DDS ROLLAND H SitelD: 015-021-002454 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ _, ncicaac ricvcu~.ivii _ i - - ~ Release Containment = Clean Up ~,_ v~aici ncavuit~c ra~.triva~.ivti -6- 02/02/2007 - h F LAM DDS ROLLAND H SiteID: 015-021-002454 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ aNc~l.a.l. nac~al.i1~ Utility'-Shut-Offs Fire Protec../Avail.. Water DU111.1111y VVVI.It,l0.111.y LCVC1; -7- 02/02/2007 ., ri F LAM DDS ROLLAND H SiteID: 015-021-002454 ~ Fast Format ~ ~ Training Overall Site ~ Employee 'rrain~ng rayC ~ Held for Future Use nCtu ivs r u~.uiC v5G -8- 02/02/2007 . ~ a~~ _~ __ .~,_ J~;, Prevention Services U~IED PROGRAM INSPECTION CHECKLIST;; H E R s F_~ __~ 900 Truxtun Ave., Suite 210 -------- = ____ ~~_~ mm~ -- - ~_,___~_- ;~ - FARE Bakersfield, CA 93301 _ ~ _ ~ . - ARTM T SECTION 1: Business Plan and Inventory Program ~~ Tel.: (661) 326-3979 - Il ~ Fax: (661) 872-2171 FACILITY NAME ~d l..l,,. A N A L~ V~ O D 5 INSPECTIOiN DATE 1~ 1 ~ INSPECTION TIME ADDRESS ~/, q -l b~ O ,p O r 1 c v -. J~ ~ t\ PH~OjNE NO. ~ vS~' ~ ~~ ~~ NO OF EMPLOYEES FACILITY CONTACT BUSINESS ID NUMBER 15-021- c~~j .Section, 9: -8~s~~ss Pfar~~a~d ln'~n~ory ~~'rograrr~ ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (C=Compiiance~ OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ~~ ^ BUSIf1eSS 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 O~ ^ 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? ~~m YES ^ ND EXPLAIN: ~~~~ 'T ~'Y E QUESTIONS REG~yARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ' I ` cZ I~-~ 1~ Inspector (Please Print) Fire Prevention / 1s` In /Shift of Site/Station # Busi 'ss i e Re o Bible Party a se Print) White -Prevention Services Yellow -Station Copy Pink =Business Copy - FD 2155 (Rev. 09/05 ~.. :. y ~04~`• ~~~z" CITY OF BAICERSFIELD FIRE DEPARTMENT ~~ ~E~~ FACILITY NAME ~o u-- a ^~~ L'P~ ~J.D S INSPECTION DATE ~ ~~ O Section 4: Hazardous Waste Generator Program EPA ID # ~X~ ~-~P Y ^ Routine ~ Combined ^ Joint Agency ^Muiti-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number ~,X ~ r+, ~ }• Authorized for waste treatment and/or storage 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 /~/ Secondary containment provided ~e,~,~ ~, ~ y`~\ ~ ~~.~,,--~ Conducts daily inspection of tanks Used oil. not contaminated with other hazardous waste ~l Proper management of lead acid batteries including labels /v/~ Proper management of used oil filters ~ Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years ~-... ~s t P o ti. Retains hazardous waste analysis for 3 years x; _ ~ Sd I ~ ~ Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal ~=~ompuance v=vtotanon Inspector: ~~ Q- ~ ~ ~' t Office of Environmental Services (661) 326-3979 White -Env. Svcs. ~ OFFICE OF ENVIRONMENTAL SERVICES • ~~ UNIFIED PROGRAM INSPECTION CHECI{LIST `w '~ ti 1715 Chester Ave., 3'd Floor, Bakersfield, CA 93301 B siness Site Responsible Party Pink -Business Copy ? rA ~~ + LAM DDS ROLLAND H ___________________________________ SiteID: 015-021-002454 + Manager Location: 4698 AMERICAN AVE A City BAKERSFIELD BusPhone: (661) 834-0911 Map 123 CommHaz Minimal Grid: 02C FacUnits: 1 AOV: CommCode: BFD STA 07 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title ROLLAND H LAM DDS / / Business Phone: (661) 834-0911x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact Phone: (661) 834-0911x MailAddr: 4698 AMERICAN AVE A State: CA City BAKERSFIELD. Zip 93309 Owner ROLLAND H LAM DDS Phone: (661) 834-0911x Address 4698 AMERICAN AVE A State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif' d: RSs : No ParcelNo: +--------------------------------------~~1-r------------------------------------+ Emergency Directives: ~~~ ~/ PROG H - HAZ WASTE GEN ~ ~ fN~p A U G ° ~ Zoos 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 su and believe the information is true, ccurate, a d complete. Sig ture Date ~~o~~ 5~ -1- 05/18/2006