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O o r, v '.~ -v !~~°c ~,=~ ~ ~ !IX Q j~~ ;Il~~ ~, ~. ,~ C ~ -- \__ ~_ MERRX X-RAY CORP Manager KEVIN MCNEIL Location: 4300 ASHE RD 110 City BAKERSFIELD SiteID: 015-021-003381 BusPhone: (661) 979-3090 Map 123 CommHaz Low Grid: 16D FacUnits: 1 AOV: CommCode: BFD STA 09 EPA Numb: SIC Code:5047 DunnBrad:12-754-7037 Emergency Contact / Title Emergency Contact / Title KEVIN MCNEIL / BRANCH MANAGER LARRY LAWSON / PRESIDENT Business Phone: (559) 292-9729x Business Phone: (858) 565-4472x 24-Hour Phone (559) 292-9729x 24-Hour Phone ( ) - x Pager Phone (559) 917-2341x Pager Phone ( ) - x Hazmat Hazards: React Contact KEVIN MCNEIL Phone: (559) 292-9729x MailAddr: 5971 E HARVARD AVE State: CA City FRESNO Zip 93727 Owner MERRY X-RAY CORP Phone: (858) 565-4472x Address 4444 VIEWRIDGE AVE State: CA City SAN DIEGO Zip 92123 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif ' d: RSs : No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN ~~ J(!~ Q V V y~ J ~~4~~ Sated on my inquiry of those individuals resprnsit;la for obtaining the informati on, I certify under penalty of law that 1 have personally examined a~~d am familiar with the information submitted and beli eve the information is true , accurate, and complp+~. ~~~-~ ~1~~ Signature Date -1- 07/12/2007 Y F MERRY X-RAY CORP SiteID: 015-021-003381 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP FIXER L 650.00 GAL Low DEVELOPER L 450.00 GAL Low DEVELOPER L 120.00 GAL Low WASTE FIXER R L 5.00 GAL Min -2- 07/12/2007 -3- 07/12/2007 i F MERRY X-RAY CORP SiteID: 015-021-003381 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME FIXER Days On Site SPECTRA FIXER 365 Location within this Facility Unit Map: Grid: CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Liquid TMixture ~ Ambient ~ Ambient DRUM/BARREL-NONMETAL AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 650.00 GAL 290.00 GAL - rit~~xtc~vu5 wrir~iv~iv 1 oWt. RS CAS# 15.00 Ammonium Thiosulfate No 7732185 5.00 Sodium Bisulfite No 7631905 5.00 Sodium Acetate No 127093 5.00 Aluminum Sulfate No 10043013 riHGKKL ASJ~~J~J1~1t;1V'lJ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Low -4- 07/12/2007 i ' F MERRY X-RAY CORP SiteID: 015-021-003381 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME DEVELOPER Days On Site SPECTRA DEVELOPER 365 Location within this Facility Unit Map: Grid: CAS# = STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient DRUM/BARREL-NONMETAL AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 450.00 GAL 200.00 GAL - HAZARDOUS COMPONENTS %Wt. RS CAS# 5.00 Hydroquinone (EPA) No 123319 5.00 Potassium Sulfite No 10117381 5.00 Sodium Sulfite No 7757837 5.00 Potassium Hydroxide No 1310583 5.00 Potassium Carbonate No 584087 5.00 Sodium Bisulfite No 7420895 L'lti[~ri[CL H. 7 JP~a~J1~1.G1V l.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Low -5- 07/12/2007 F MERRY X-RAY CORP SiteID: 015-021-003381 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME DEVELOPER Days On Site KODAK DEVELOPER 365 Location within this Facility Unit Map: Grid: CAS# Liquid TMixtur~mbient~E ~ AmbientT~E DRUM/BARRELENONMETAL~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 120.00 GAL 40.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 3.00 Hydroquinone (EPA) No 123319 10.00 Potassium Sulfite No 10117381 5.00 Potassium Acetate No 127082 5.00 Potassium Bisulfite No 68310087 I1tiL~riRL tiw 7.7 P.~~J J1"1LilV 1 A TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Low ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site SPENT PHOTOGRAPHIC FIXER 365 Location within this Facility Unit Map: Grid: CAS# Liquid TWaste -TAmbient~E ~ AmbientT~E ~ PLASTICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 5.00 GAL 5.00 GAL 5.00 GAL CO ~~~~~~~ MPONENTS %Wt. RS CAS# Silver No 7440224 ritiL~riRL tia AP~.7.71.1L,1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -6- 07/12/2007 F MERRY X-RAY CORP SitelD: 015-021-003381 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 04/16/2007 IT IS THE RESPONSIBILITY OF THE PERSON FIRST RECOGNIZING A SPILL OR HAZARDOUS CONDITION IN THE FACILITY TO NOTIFY THE PROPER INDIVIDUAL. THE INDIVIDUAL RESPONSIBLE AS EMERGENCY COORDINATOR ARE: KEVIN MCNEIL, BRANCH MANAGER, 559-292-9729 AND CELL 559-917-2341, OR MATT GROGAN 661-979-3090. THE EMERGENCY COORDINATOR WILL NOTIFY THE PROPER EMERGENCY RESPONSE AGENCY (BAKERSFIELD FIRE DEPT, OES) NOTIFICATION WILL OCCUR WHEN IT IS BELIEVED THAT THE RELEASE WILL POSE A HAZARD TO HUMAN HEALTH AND SAFETY, TO PROPERTY, OR THE ENVIRONMENT. 9 Employee Notif./Evacuation 04/16/2007 VERBAL NOTIFICATION WILL OCCUR FIRST. ADDITIONAL NOTIFICATION WILL BE BY BOTH LAND-LINE AND CELLULAR PHONE. Public Notif./Evacuation 04/16/2007 THE EMERGENCY COORDINATOR WILL NOTIFY ALL NEIGHBORING FACILITIES OF THE RELEASE, TO ENSURE THE SAFETY OF THEIR EMPLOYEES. Emergency Medical Plan 04/16/2007 911 - FIRE, POLICE, AND MEDICAL SERVICES. 326-3979 - KERN CO ENVIRONMENTAL HEALTH DEPT. 800-852-7550 - CALIFORNIA OFFICE OF EMERGENCY SERVICES. -7- 07/12/2007 F MERRY X-RAY CORP SiteID: 015-021-003381 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention 04/16/2007 PROPER STORAGE OF CHEMICALS AND HAZARDOUS MATERIALS IS IMPORTANT IN PREVENTING ACCIDENTS. ALL CHEMICALS ARE TO BE STORED IN THE PROPER DOT-APPROVED CONTAINERS. INSPECTIONS OF THE CONTAINERS SHOULD BE PERFORMED DAILY TO PREVENT ANY ACCIDENTAL RELEASES. THE 55-GAL DRUMS AND 5-GAL PLASTIC CONTAINERS ARE TO BE CLEARLY LABELED WITH THE CONTENTS. DO NOT REUSE CONTAINERS FOR ANY OTHER CHEMICALS OTHER THAN THE ORIGINAL CONTENTS. Release Containment 04/16/2007 55-GAL DRUMS SHALL BE PLACED ON PALLETS FOR STORAGE PURPOSES. NO MORE THAN FOUR 55-GAL DRUMS SHALL BE PLACED ON ANY ONE PALLET. PALLETS WITH DRUMS ARE TO BE PLACED ON THE FLOOR. WHERE PROPERLY ENGINEERED SHELVING IS IN PLACE, PALLETS WITH DRUMS MAY BE STORED. 9 Clean Up 04/16/2007 AFTER MATERIAL IS CONTAINED, DETERMINE THE AMOUNT TO BE CLEANED UP AND DISPOSED OF. MATERIAL SHOULD BE DISPOSED OF PROPERLY, FOLLOWING ALL FEDERAL AND STATE REGULATIONS FOR DISPOSAL. Other Resource Activation -8- 07/12/2007 F MERRY X-RAY CORP SiteID: 015-021-003381 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~7~JCC:I CL1 11d'G CLI U.7' Utility Shut-Offs 04/16/2007 IN WHSE, ELECT PANEL 4' FROM ROLL-UP DOOR. -. ~ , 1'11G rl Vl..G I...~l~V Gill. YYQ I.Gt Building Occupancy Level 12/11/2006 3 EMPLOYEES -9- 07/12/2007 -- ~ - :+~ P MERRY X-RAY CORP SiteID: 015-021-003381 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 04/16/2007 ~ BRIEF SUMMARY OF TRAINING PROGRAM: TRAINING ON THE PROPER HANDLING, STORAGE, AND MIXING OF CHEMICALS WILL BE ON A QUARTERLY BASIS, UNLESS NEW ISSUES ARISE. TRAINING WILL INCLUDE: SAFE MOVEMENT OF CHEMICALS; PROPER CHEMICAL TRANSFER METHODS; MSDS DISCUSSIONS; PROPER MIXING TECHNIQUES; AND EMERGENCY RESPONSE, SPILL PREVENTION PROCEDURES. ALL TRAINING IS IN ACCORDANCE WITH THE MXR CORP SAFETY PROCEDURES MANUAL. COPIES OF INSPECTIONS AND MXR SAFETY PROCEDURES MANUAL WILL BE AVAILABLE BOTH AT THE BRANCH AND AT CORP HEADQUARTERS. rayc c. Held for Future Use Held for Future Use -lo- 07/12/2007 MERRY X-I?~P,Y CORP SiteID: 015-021-003381 Manager KEVIN MCNEAL t!~ BusPhone: (661) 833-9416 Location; 4300 ASHE RD 110 Map 123 CommHaz Low City BAKERSFIELD Grid; 16D FacUnits: 1 AOV: CommCode: BFD STA 09 SIC Code:5047 EPA Numb: DunnBrad:12-754-7037 Emergency Contact /~,,,,~wTitle Emergency Contact / Title KEVIN - A'fG-i>IEA£~ ~`~-ti =~ ~- / @I'9 MANAGER ~ ~~ ~ -'~° ~ ~_ • ~ / '3,~~-•~. ~. ~1~~~ , Business Phone: (559) 292-9729x Business Phone: (sue+) z-G'Z--~~~2~x 24-Hour Phone (ss~) 2~+Z-`~+~~x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone (s~~ )~+ +~ -'z ~ 1 x Hazmat Hazards: React Contact KEVIN ~fCNE~ Mc~~+~.-- ~ ~ ~ Phone• (559) 292-9729x MailAddr: 5971 E HARVARD AVE .... State: CA City FRESNO Zip 93727 Owner MERRY X -RAY CORP Phone : (•5-5~ ) 2~2--9'~~~x- Address 5~9 -~E tiuy~-+ ~+e..~+~-~~« State: CA ~S~ sc~5• ~~~Z- C i ty P`Ri~SNO c ~a,--- t~ + c= c-~ Zip -93~~-7~- a~ i Z3 Period to TotalASTs: = Gal Preparers ~ TotalUSTs: = Gal Certif'd: _:_._ RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN - (~. n~/~}0 -~(" l Y `V" ENT'p q pR ~ 6 2 ~~7 -1- 02/05/2007 F MERRY X-RAY CORP SiteID: 015-021-003381 ~ ~ Hazmat,zInventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP FIXER L 650.00 GAL Low DEVELOPER L 450.00 GAL Low DEVELOPER L 120.00 GAL Low WASTE FIXER R L 5.00 GAL Min -2- 02/05/2007 F MERRY X-RAY CORP ~ Irnventoury Item 0001 COMMON NAME / CHEMICAL NAME FIXER SPECTRA FIXER ... Location within this Facility Unit STATE Liquid SiteID: 015-021-003381 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid:. CAS# TYPE PRESSURE TEMPERATURE -= Mixtur~Ambient ~ Ambient AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 650.00 GAL 290.00 GAL ri[',GHxUVU~ ~~t~irvlv~lvl5 $Wt. RS CAS# 15.00 Ammonium Thiosulfate No 7732185 5.00 Sodium Bisulfite No 7631905 5.00 Sodium Acetate No 127093 5.00 Aluminum Sulfate No 10043013 riHGHKL H. 7 J C.»1~1L' 1V l J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Low CONTAINER TYPE _ DRUM/BARREL-NONMETAL -4- 02/05/2007 F MERRY X-RAY CORP SiteID: 015-021-003381 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME DEVELOPER Days On Site SPECTRA DEVELOPER 365 Location within this Facility Unit Map: Grid: CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Liquid TMixture ~-Ambient ~ Ambient DRUM/BARREL-NONMETAL AMOUNTS AT THI5 LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 450.00 GAL 200.00 GAL HAZARDOUS COMPONENTS ~kWt . RS CAS# 5.00 Hydroquinone (EPA) ~ No 123319 5.00 Potassium Sulfite No 10117381 5.00 Sodium Sulfite No 7757837 5.00 Potassium Hydroxide No 1310583 5.00 Potassium Carbonate No 584087 5.00 Sodium Bisulfite No 7420895 t1HGt-~LSL. Li.>JL' JJ1~1r,1V 1 J TSecret RS BioHaz Radioactive/Amount ...EPA Hazards NFPA USDOT# MCP No No No No/ ~ Curies / / / Low -5- 02/05/2007 F MERRY X-RAY CORP SiteID: 015-021-003381 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME DEVELOPER Days On Site KODAK DEVELOPER 365 Location within this Facility Unit Map: Grid: CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~Ambient ~ Ambient DRUM/BARREL-NONMETAL AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 55.00 GAL 120.00 GAL 40.00 GAL t1AGt-~KLUUJ lilJl•lYlJ1V r.1V 1 J ~Wt. RS CAS# 3.00 Hydroquinone (EPA) ~ ~ No 123319 10.00 Potassium Sulfite No 10117381 5.00 Potassium Acetate No 127082 5.00 Potassium Bisulfite No 68310087 t1L-1GHiCL L'a. 7JL'.7J1~1Z'.1V1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Low ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site SPENT PHOTOGRAPHIC FIXER 365 Location within this Facility Unit Map: Grid: CAS# Liquid TYPE PRESSURE- "TEMPERATURE ~STICTCONTAINERE TWaste ~-Ambient ......~ .Ambient AMOUNTS AT'THIS LOCATION Largest Container .Daily Maximum I Daily Average 5.00 GAL 5.00 GAL 5.00 GAL rltic,[-u[uv V J ~.vl•lrviv~ly 1 a °s Wt. RS CAS# Silver No 7440224 r1Ca[~11RL Li J JP~J J1.1r+1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -6- 02/05/2007 F MERRY X-R.AY CORP SiteID: 015-021-003381 ~ ,; Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification _, ~ ~~ L'lllt./1 VY GG 1•IV V11 ~ JJ V~jQ l~. ucaV1V11 / .-. r ILiJ l l V LY V V 11 .r~ L`~V,~~0.~/l).. {,L0. 1..(1 VLL L'111G1yGL1\..Y 1.1GU11.0.1 C1Q11 ~a.c',:c ~L ~t ~~~SS ~~U~ -7- 02/05/2007 F MERRY X-RAY CORP SiteID: 015-021-003381 ~ Fast Format ~ ~ MitigaCion/Prevent/Abatemt Overall Site ~ 1CC1C0.t~C riCVC111.1 V11 KH1ed5H ~.VIlLd1I11ACi1L Sly \ z_ ~ ~~ i til~"is S T_"'~S = L1Cd11 ;-U~lJ C •rY t"~ l~v ~~ ~ ,~1~ 7 s S ~~ ~S V1..11G1 AG.7V Ui~...G L1~...L1 V0.l.1 VLl -8- 02/05/2007 F MERRY X-RAY CORP SitelD: 015-021-003381 ~ ' \, - Fast Format ~ ~ Site Emergency Factors Overall Site ~ J~JCG1d1 IldLdLUa Utility Shut-Offs ,. , ~ - ... L" 1 1 G t 1 V I.. G 1. •~ L3 V Q i l • \\ Q 1.. G 1 Building Occupancy Level 12/11/2006 3 EMPLOYEES -9- 02/05/2007 F MERRY X-RAY CORP SiteID: 015-021-003381 ~ '~-~° Fast Format ~ ~ Training Overall Site ~ Employee Trair~~ng ~;.:-~ - ~L=-mss. ,~r-~ s ~..~~.~.t rayc ~ Held for Future Use 1'1C 11.1 LVL rUI. ULC V.~.~C -10- 02/05/2007 I~ MERRY X-RAY CORPORATION SERVICE IS OUR ONLY PRODUCT Business Plan Operator: Merry X-Ray Chemical Corporation 4300 Ashe Road, Suite 110 Bakecsftetd, CA 93313 Phone (559} 292-9729 FAX (559) 347-6799 Owner: Merry X-Ray Chemical Corporation 4444 Viewridge Avenue San Diego, CA 92123 Phone (858) 565-4472 FAX (858) 565-2409 Contacts: Kevin McNeil -Branch Manager (559) 292-9729 Larry Lawson -President (858) 565-4472 Release Prevention Storage Proper storage of chemicals and hazardous materials is important in preventing accidents. All chemicals are to be stored in the proper D.O.T. approved containers. Inspections of the containers should be performed daily to prevent any accidental releases. The 55-gallon drums and 5-gallon plastic containers are to be clearly labeled with the contents. Do not reuse containers for any other chemicals other than the original contents. 55-gallon drums shall be placed on pallets for storage purposes. No more than 4 (55 gallon) drums shall be placed on any one pallet. Pallets with drums are to be placed on the floor. Where properly engineered shelving is in place, pallets with drums may be stored. ~~ MERRY X-RAY CORPORATION SERVICE IS OUR ONLY PRODUCT Release Prevention (cont.) Storage (cont.) Pallets should be moved by the use of either a forklift or a pallet jack. It is important to be aware of objects in the warehouse when moving chemicals. Premixed chemicals (concentrated. chemicals mixed to manufacturer's specifications with water) are to be stored in 5-gallon D.O.T. approved carboy plastic containers. These colored containers are to be filled with end-user film developing chemicals for delivery to clients. These containers will be filled at the Fresno distribution center and transported to the Bakersfield warehouse. The 5-gallon carboy containers will be stored on pallets, no more than 3 containers high, and moved by pallet jack or forklift. The pallets should be secured, with either shrink-wrap or strapping to ensure safe transport to Bakersfield. Transfers The transfer of chemicals during the mixing process requires the operator to be attentive at all times. The transfer of chemicals from 55-gallon drums to the mixing tank wiU require a drum pump. Attach. the pump body to the course-threaded port on the drum, and then attach the hose inlet to the tank port on the mixing tank. Tighten the latches on the disconnect fitting. The operator must control the pump at all times during the transfer process. 5-gallon containers may be poured. directly into the mixing tank, at the proper interval, from the platform adjacent to the mixing tank. Care should be taken to ensure that all of the contents are added directly into the mixing tank, without any spillage. Proper eye, face, and skin protection should be worn when adding these chemical components during the mixing process. MERRY X-RAY CORPORATION SERVICE IS DUR ONLY Pl10DUCT Release Prevention (cont.) Transfers (cont.) when pumping finished products from the mixing tank into 5-gallon carboys, the operator must be attentive at all times during the process. The containers to be filled must. be cleaned and organized for bottling. Filled carboys are to be stored on pallets for transfer and storage. Employee Training Training on the proper handling, storage and mixing of chemicals will be on a quarterly basis, unless new issues arise. Training will include: Safe movement of chemicals Proper chemical transfer methods. MSDS discussions. Proper mixing techniques. Emergency response, spill prevention procedures. All training is in accordance with the MXR Corporate Safety Procedures Manual. Copies of inspections and MXR Safety Procedures Manual will be available both at the branch and at Corporate headquarters. Release Containment Containment In the event of a spill or release, it is important to first assess the situation: 1. Is it a spill or leak? 2. How much material has/is leaking or released? 3. What container(s) is/are involved? 4. What can be done immediately to minimize the impact of the release? /~ MERRY X-RAY CORPORATION SERVICE IS OUP ONLY PRODUCT Release Containment (cont.) Containment (cont.) To contain a spill, diking material should be placed around the spill, to prevent any further spread. If a container is leaking, place the container in a containment drum or on a containment pallet. Place diking material around leaked. or spilled material for clean-up. Place absorbent material, located in the spill equipment container, to collect material for proper disposal. Clean Up Procedures Clean Up After material is contained, determine the amount to be cleaned up and disposed of. Material should be disposed of properly, following all Federal and State regulations for disposal. ~. MERRY X-RAY CORPORATION SERVICE IS OUR ONLY PROOULT Notification & Evacuation Procedures Notification Who is Responsible? It is the responsibility of the person first recognizing a spill or hazardous condition in the facility to notify the proper individual(s). The individual(s) responsible as emergency coordinator are: Kevin McNeil Branch Manager (559) 292-9729 Cell (559) 917-2341 Matt Grogan Bakersfield (661) 979-3090 How will notification Occur? In the Fresno distribution center, verbal notification will occur first. Additional notification will occur by both land-line phone and cellular. In the Bakersfield warehouse, as it is relatively small, verbal notification will occur first. Additional notification will be by both land-line and cellular phone. Evacuation Procedures for Evacuation After a notification to evacuate has occurred, the employees will meet outside the building, in the parking lot, away from the front doors. In Fresno, this meeting place is to the east side of the front office door. in Bakersfield, the meeting place is to the north side of the front door. The emergency coordinator will count the employees for the. head count. Facility maps. are located in both the warehouse storage areas and in the office, indicating the evacuation staging areas. ., ,. ~~ MERRY X-RAY CORPORATION SERVICE IS OUfl ONLY PRODUCT Notification & Evacuation Procedures (cont.) Emergency Notification The emergency coordinator will notify the proper emergency response agencies (ie: Fresno Fire Dept., Fresno County Environmental Health, California Office of Emergency Services, etc... ). Notification will occur when it is believed that the release will pose a hazard to human health and safety, to property, or the environment. The emergency coordinator will also notify all neighboring facilities of the release, to ensure the safety of their employees. The Emergency Coordinator will report to this information to the Emergency Response Agencies: Exact location of the Release. Name of Person reporting the Release. Hazardous materials involved in the Release. Estimated quantity of the materials involved in the Release. Potential hazards and conditions presen#ed by the materials released. Emergency Response Agencies 911 Fire, Police and Medical Services (661) 326-3979 Kern County Environmental Health Dept. (800) 852-7550 California Office of Emergency Services i ~ ~ ~ HMMP HAZaRDO ATERIALS MANAGEMENT PLAN APPLICATION FORM FOR BIJSNESS OVIMER/OPERATOR A'itON R~ (HAZARDOUS MATERIALS FACILITY INFORMATION 8 H x 7 D F/R6 ARTAI T ~~ Bakersfield Fire Dept. FIRE PREVENTION 900 'IYuxtun Ave., Suite 210 Bakersfield, CA 93301 Tel: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 2 ~~~yl I. FACILITY IDENTIFICATION FACILITY ID NO. i ear egmning ioo Year Ending ~ 2004 2004 USINESS NAME (Same as FACILITY NAME or DBA- a Doing Business As) ~h ~ USI SS PHONE 7pp Source0ne Healthcare }~~,, Technologies, Inc I~L~" I ~~ (661)-833-9416 ITE ADDRESS ioa 4300 Ashe Road Suite 110 ITY 104 Ip i Bakersfield, CA ~ 93313 ~ DUN&BRADSTREET 12-754-7037 ~~ IC CODE 5047 (4 Digit #) OUNTY Kern ios PERATOR NAME cos OPERATOR PHONE ~~ Matt Gro an (661.) 979-3090 p _ II. OWNER INFORMATION WNER NAME >>> OWNER PHONE Source0ne Healthcare Technologies, Inc (440) 701-1603 WNER MAILING ADDRESS >>3 8020 Tyler Boulevard ITY na STATE ns IP ns Mentor OH 44060-4825 I IR. ENVIRONMENTAL CONT/4CT ONTACT NAME m CONTACT PHONE iie John Nadzan (440) 701-1269 ONTACT MAILING ADDRESS 719 8020 Tyler Boulevard ITY ~zo STATE izi ZIP Mentor OH 44060-4825 PRIMARY IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME 128 Matt Grogan George Maddox ITLE 124 ITLE 129 Service En ineer Warehouse Manager BUSINESS PHONE 125 BUSINESS PHONE 130 (661) 979-3090 cell (559) 347-9747 4HOUR PHONE 126 4-HOUR PHONE 131 .661 979?3090~ce11 ~ (559) 999-1336 cell AGER No N/A ~ 127 AGER No N/A 132 V. CERTIFICATION ertification: 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 in this inventory and believe the information is true, accurate, and complete. IGN F R/OPERATOR _ 133 ATE 134 NAME OF DOCUMENT PREPARER 135 ~• John Cunnin ham NA OWNERlOPERATOR (pri 136 ITLE OF OWNER/OPERATOR 137 John Nadzan - ~ ~~~.- ""•~~~ `, Director of H& ~,p~~ N ~ ~~~ay q~~~ ~. ~ FD2009 I~~~~~n~'~~ ~ °~~~~~~~1 ~ ~(,y~o ENT'D FEB 17 2006 ~~ r '~'' (HMMP) ~_ _ ._i. HAZARDOUS MATERIALS MANAGEMENT PLAN BUSINESS ACTIVITIES PAGE (HAZARDOUS MATERIALS FACILITY INFORMATION) _~,` B fl R S F 7 D FfRB ARrM ! Bakersfield Fire Dept. FIRE PREVENTION 900 Trtaxtun Ave., Suite 210 Bakersfield, CA 93301 Tel: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 L FACILITY IDENTIFICATION FACILITY ID # (For Office use only -please leave blank) 3 EPA ID # DBA /FACILITY NAME ~ Source0ne Healthcare Technologies, Inc. II. ACTIVITIES DECLARATION DOES Your Facility ... If Yes, Please Complete ... t2 A. HAZARDOUS MATERIALS • OES FORM FD2086) Chemical Description Form) 13 1. Have on site (for any purpose) hazardous ~ Yes ^ No • CONSOLIDATED COMPLIANCE PLAN materials at or above 55 gallons for liquids, Minimum required olannino elements: 500 pounds for solids, or 200 cu. ft. for ~ ~ Yes ^ No Emergency Response Plan Maps coin ressed ases include li uids in ASTs and P 9 ( q Training USTs)? Prevention B. REGULATED SUBSTANCES (RS) ^ Yes ~3 No • DOES FORM FD2oas) Chemical Description Form) 131 1. Have on site RS at greater than the threshold planning quantities established by the California • Risk Management Plan (RMP Submit to USEPA) Accidental Release Prevention program • CONSOLIDATED COMPLIANCE PLAN . Incorporating CatARP Program Elements (CaIARP)? C. UNDERGROUND STORAGE TANKS (USTs) 13 1. Own or operate Underground Storage Tanks? ^ Yes ~ No • UST FACILITY FORM FD2ossb ) • UST TANK FORM (One Per Tank) 2. Intend to upgrade existing or install new USTs? ^ Yes ~ No • UST FACILITY FORM FD2o68b) 13 • UST TANK FORM (One Per Tank) FORM FD2068d • UST INSTALLATION FORM One Per Tank FORM FD2068f D. TANK CLOSURE /REMOVAL 2. Need to report closing an UST that held hazardous ^ Yes ~ No • UST TANK FORM (Closure section -one per tank) materials or 3. Need to report the closure /removal of a tank that ^ Yes ~ No • UST TANK CLOSURE FORM was classified as hazardous waste and cleaned on- site? E. ABOVEGROUND PETROLEUM STORAGE TANKS (ASTs) ^ Yes ~No • CONSOLIDATED COMPLIANCE PLAN 1. Own or operate ASTs above these thresholds; • Incorporating Federal Spill Prevention Control and any tank capacity is greater than 660 gallons or the Countermeasure (SPCC) Elements pursuant to 40 CFR Part 112. total capacity for the facility is greater than 1,320 F. HAZARDOUS WASTE EPA ID NUMBER -Provide on this page 1. Generate hazardous waste? ^ Yes C~No • To obtain EPA ID Number, please phone (s16j 324-1781 2. Recycle more than 100 kglino of recyclable ^ Yes C~No • RECYCLING FORM materials at the same location it was generated? 3. Recycle more than 100 kglino of recyclable ^ Yes l~No • RECYCLING FORM materials at an off-site location different from the point of generation? 4. Treat Hazardous Waste on site? ^ Yes ~No • TP FACILITY FORM (DTSC FORM 1772) • TP UNIT FORM (One per unit) 5. Subject to Financial Assurance requirements? ^ Yes ~ No • CERTIFICATION OF FINANCIAL ASSURANCE 6. Consolidate Hazardous Waste generated at a ^ Yes ^~No • REMOTE WASTE /CONSOLIDATION SITE NOTIFICATION FORM remote site? Note: If you checked YES to any part of Sections IIA - IIF above, then in addition to the forms requested above, please Submit i OES Form 2730. FD2088 f (HMMP) HAZARDOUS MATERIALS MANAGEMENT PLAN APPLICATION FOR SECTION DISCOVERY AND NOTIFICATION (FORMS) B $ ~ P!R/ ARfA/ T Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (661) 326-3979 Fax: (661) 852-2171 INSTRUCTIONS Page. 1 of 2 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. SECTION I: FACILITY IDENTIFICATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) Source0ne Healthcare Technolo ies Iris. ADDRESS (For local use only) 4300 Ashe Road Suite 110 Bakersfield, CA 93313 FACILITY ID NO. ~ SECTION 11.1: DISCOVERY AND' NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES:Material storage areas are inspected on a daily basis. The containers in these areas are checked for general condition, the presence of leak"s from the containers, and general housekeeping. B. EMPLOYEE AND AGENCY NOTIFICATION: FaClllt ersonnel must immediatel identif onse y p y y ~:F~nergency~tResp =Coordinator, ('George Maddox), or alternative. .The ERC will call 9-1-land the offic of Emergency Services to report any spills that are a threat to life, safety or environment. For non-emergency spills will call Bakersfield Fire Department of Environmental Services. C. ENVIRONMENTAL RESPONSE MANAGEMENT: In the event of hazardous material release, the person making the discovery of the-_release will contact the ERC.or his alternate. The.-ERC or his alternate will have the proper MSDS when cleanup team arrives. The ERC is reponsibl for cleanup. D. EMERGENCY MEDICAL PLAN: In case of contact with spilled materials immediately flush eyes and and skin with running water for fifteen minutes. Wash skin with soap and water. Remove and isolate all contaminated clothing and shoes. ERC or alternate will ensure all aforementioned first aid is provided before arrival of emergency services. The hospital is located: Mercy Southwest Hospital, 400 OLd River Rd, Bakersfield CA SECTION 11.2: RELEASE RESPONSE PLAN ~ A. HAZARDASSESMENTANDPREVENTIONMEASURES: All products are stored within sealed containers and placed on pallets to reduce the likelihood of a release. Containers are protected from wind, rain, vehicular traffic, and moving machinery. Containers are stored or physically separated.-from incompativle material. B. RELEASE CONTAINMENT AND/OR MITIGATION: All hazardous materials are stored inside the warehouse. In the event of a spill, a boom will be placed around any floor drains in the spill area: C.CLEAN-UP AND RECOVERYPAOCEDURES: Small dry spills: with clean shovel, place material into a ~:. . clean, dry container and cover loosely. Small spills: take up with non-combustable absorbent material;"place, in container for later disposal. Large spills: Dike ahead of linnid mill to rnntain_ nse ahsnrhant materials and nlare into nnntainer minimize spreading. ~ FD2085 1` , Page 2 of 2 --- - - SECTION 11.2: RELEASE-'RESPONSE PLAN-COWL UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: N /A At the electical shut off located in the southeast corner of facility (seewmap ELECTRICAL: WATER: At the washer/dr er and bathrooms in southeast corner of facilit (see map) SPECIAL: N/A PRIVATE FIRE PROTECTION/WATERAVAILABILITY: Flre extinguishers are located in the office (northwest A. PRIVATE FIRE PROTECTION: corner'of facility) and in the warehouse:~_n the southeast :~:corner:'~aThet_uriit:_has ceiling sprinklers. B. WATER AVAILABILITY (FIRE HYDRANT): Two fire hydrants are located at the entrance to the complex: on Ashe Street. SECTION III: TRAINING UMBER OF EMPLOYEES: -- - - - - - - 5 ATERIAL SAFETY DATA SHEETS ON FILE: MSDS stored electronically. Facility personnel can access is er in 'ce. RIEF SUMMARY OF TRAINING PROGRAM: Training is accomplished via the internet,(s-faff meetings and news letters. Employees are trained on varying levels dependent on their specific job function. Training program includes: methods for safe handling of hazardous materials; Procedures for coordination with local emergency response organizations; Use of emeegency response equipment and supplies under the control of the handler including the proper cleanup of spilled materials. Familiarity with the plans and procedures specified in :the Business Plan GE RTI°FI C-ATI O,N Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that 1 have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. IGNA O R /OPERA E AT REPRESENTATIVE DATE 477 ~ y a.S A SI R (print) 478 ITLE OF SIG R 479 John Nadzan Director of EH&S FD2085 nrnmr~ HAZARDOUS MATERIALS NIANAGEIAENT PL1W -~ ~- ':~, ~ ]BBk~x'sSelcl r`ire Dept. o '-~ FIRE PREVENTION •,s~z~ ~:~~~r~~sc.~,-t:=ti~'t~~u:~r~~:ns~~r~~ ~a.~3!._ ...~ ~IRI c;()0 Tn~xtun A~~e.. Suite :.~ 10 ` Si7E 8~ FACILITY D1~1~`arRAlIA ?~ ~~>rA- T A 93301 Ba.ker::field, C Tel: (6&1) 326-3979 ~.; ~ FaX: (661) 852-217: Page ~ of 1 ~ __._.. __ r----------1 ~~ ^~ 51TE DIAGRAM L_ i FACILITY DiAGFtAM :Businesstvame: Sp~~~ 4rvF ~-}~tL1h cfl~-~ ~7~G~+~~~-oG~~s ._..__- Business Address: ~3 ~ ~ ~~.~~ Ro~~ S~ ~-~- r) U -_ ~l~~£2S ~~ ~L ~ Ct9 `~ 3 3 ~ ~ -a~ pG i A~ I i r a J 4 i~ 0 0 I pV oTE' lvoT Ta Sc.~A~ E- ~ pRd~.,,~ i ~ s FLo ~,L ~ i /9 ~l~z~~ o ~v QAI )~ll,~ S vh a 1\ S 1,,x,1 v~ w ~ ~$ C ;i. ~=P FE tvi~aa-k5 ~n~~~'~~~~~: S ATE !S nGGV~s crli ~ ,,C,Zs~ ~h~ .~.;-~o,;R~ i NORTH Please i~1dlCdte direction u/ IV~rtf+ TOTAL F,1~ 2 I ~ i 3` ~HMMP) tsasersneia r~Yre liept. HAZP~RDOUS MATERIALS MANAGEMENT PLAN Environmental Services F/R6 900 Tn~xtun Ave., Ste. 210 CHEMICAL DESCRIPTION FORM "~~ '' Bakersfield, CA 93301 HAZARDOUS MATERIALS INVENTORY. Tel: (661) 326-3979 (One form per material, per building, or area.} ^ NEW ^ ADD ^ DELETE ^ REVISE 200 Paae1 of 2 I: FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 Source0ne Healthcare Technologies, Iric. CHEMICAL LOCATION 201 CHEMICAL LOCATION 202 4300 AsHe Road SUlte 110. Bakersfield, CA 93313 CONFIDENTIAL(EPCRA) ^ YesC~No FACILITY ID No. 1 MAP No. (optionsp 203 GRID NO. (optional) 204 i IL CHEMICAL INFORMATION CHEMICAL NAME 205 20~ TRADE SECRET ^ Yes 17~No If Sub'ect to EPCRA fer to instr ctions COMMON NAME 207 Spectra ~' 1Xer EHS' ^ Yes ^ No 20ti~, CAS No. 209 'If EHS is "Yes," all amounts b elow must be in lbs. FIRE CODE HAZARD CLASSES (Complete if requested by local Lire chief) 210 1 TYPE 211 21 CURIES 213 D p PURE ~ m MIXTURE ^ w WASTE RADIOACTIVE: ^ Yes C~{No LARGEST CONTAINER 215 PHYSICAL STATE ^ s SOLID ~I I LIQUID ^ g GAS 214 55 GAL Drum 216 FED HAZARD CATEGORIES ^ 1 FIRE ^ 2 REACTIVE ^ 3 PRESSUR E RELEASE C~4 ACUTE H EALTH ^ 5 CHRONIC HEALTH (Check all that apply) ANNUAL WASTE AMOUNT 217 MAXIMUM 218 DAILY AMOUNT 650 GAL AVERAGE DAILY AMOUNT 290 219 GAL STATE WASTE CODE 220 221222 ^ UNITS ~ ga GAL ~ ^ d CU FT ^ Ib LBS ^ to TONS DAYS ON SITE 365 If EHS, amotmt must be in lbs. 223 STORAGE CONTAINER (Check all that apply) ^ a ABOVEGROUND TANK ^ t CAN ^ k BOX ^ p TANK WAGON ^ b UNDERGROUND TANK ~ g CARBOY ^ I CYLINDER ^ q RAIL CAR ^ c TANK INSIDE BUILDING ^ h SILO ^ m GLASS BOTTLE ^ r OTHER ^ d STEEL DRUM ^ i FIBER DRUM ^ n PLASTIC BOTTLE C~ e PLASTICMONMETALLIC DRUM ^ j BAG ^ o TOTE BIN 224 STORAGE PRESSURE ~1 a AMBIENT D as ABOVE AMBIENT ^ ba BELOW AMBIENT ~ 225 STORAGE TEMPERATURE ~ a AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT ^ c CRYOGENIC °foWT HAZARDOUS.. COMPONENT EHS CAS # 1 15 226 Ammonium Thiosulfate 227 ^ Yes ^ No 223 7732-18-5 2z 2 5 230 231 ^ Yes ^ No 232 23 Sodium Biosulfite 7631-90-5 a 5 z3a Sodium Acetate 239 ^ Yes ^ No 240 127-09-3 241 5 5 242 243 ^ Yes ^ No 244 24 Aluminum Sulfate. 10043-OL-3 I;IL SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 24 John Nadzan Director of EH&S ~ ~ ®~ ~ ~~ FD2086 V (HMMP) -° tsasersneia mire liept. ''~- HAZARDOUS MATERIALS MANAGEMENT PLAN Environmental Services ~ - _ ,. 8 B R P D FIRE 900'IYuxtun Ave., Ste. 210 A_,R"rB r Bakersfield, CA 93301 CHEMICAL DESCRIPTION FORM ! ,,~~ Tel: (661) 326-3979 HAZARDOUS MATERIALS INVENTORY ^ NEW ^ ADD ^ DELETE ^ REVISE 200 (One form per material, per building, or area. J Paae1 of 2 F. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 Source0ne Healthcare Technolo ies Inc. CHEMICAL LOCATION 201 CHEMICAL LOCATION 20 CONFIDENTIAL (EPCRA) ^ Yes No .4300 Ashe Raad Suite 110 Bakersfield CA 93313 FACILITY ID No. 1 MAP No. (optional) 203 GRID NO. (optional) 20 IL CHEMICAL INFORMATLON CHEMICAL NAME 205 20 TRADE SECRET ^ Yes _ ^XNo If Sub'ect to EPCRA afar to i structions COMMON NAME 207 EHS' ^ Yes ^ No S ectra Develo er 20 CAS No. 209 'If EHS is "Yes," all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 210 TYPE 211 21 CURIES 21 ^ p PURE ~ m MIXTURE ^ w WASTE RADIOACTIVE: ^ Yes ~] No LARGEST CONTAINER 215 PHYSICAL STATE ^ s SOLID X 1 LIQUID ^ g GAS 214 55 GAL Drum z1s FED HAZARD CATEGORIES ^ 1 FIRE ^ 2 REACTIVE ^ 3 PRESSURE RELEASE ~7 4 ACUTE H EALTH ~ 5 CHRONIC HEALTH (Check all that apply) "" ANNUAL WASTE 217 MAXIMUM 218 AVERAGE 219 STATE WASTE 22 AMOUNT DAILY AMOUNT 450 GAL DAILY AMOUNT 200 GAL CODE 221222 ^ UNITS ~ ga GAL ~ ^ cf CU FT ^ Ib LBS ^ to TONS DAYS ON SITE 365 If EHS, amount must be in lbs. 22 STORAGE CONTAINER ^ k BOX ^ p TANK WAGON (Check a!i that apply) ^ a ABOVEGROUND TANK ^ t CAN ^ b UNDERGROUND TANK ~ g CARBOY ^ I CYLINDER ^ q RAIL CAR ^ c TANK INSIDE BUILDING ^ ~ h SILO ^ m G SS BOTTLE ^ r OTHER ^ d STEEL DRUM ^ i FIBER DRUM ^ n PLASTIC BOTTLE C~ e PLASTICMONMETALLIC DRUM ^ j BAG ^ o TOTE BIN 22 STORAGE PRESSURE ~ a AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT 22 STORAGE TEMPERATURE ~ a AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT ^ c CRYOGENIC %WT HAZARDOUS COM,P,ON.ENT EHS CAS # 1 5 z2s H dro uinone 227 Yaa ^ No 22s 123-31-9 zz 2 230 231 ^ Yes ^ No 232 23 5 Potassium Sulfite 10117-38-1 4 5 236 SOdlum Sulfite 239 ^ Yes ^ No 240 7757_83_7 241 5 5 242 243 ^ Yes ^ No 244 24 Potassium Hydroxide 1310-58-3 III. SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE IGNATURE DATE 2461 John Nadzan Director of EH&S ~ S O ~ FD2086 V ;!_ ._ _~. WT Hazardous Component EHS CAS # 5 5 Potassium Carbonate ^ Yes ^ No 584-08-7 6 5 Glutaraldeh de bis (Sodium Bisulfite) ^ Yes ^ No 7420-89-5 (IiMMP> ~~ tsaxersnela r~Yre wept. ~~ HAZARDOUS MATERIALS MANAGEMENT PLAN Environmental Services ... - _ F/RB 900 Truxtun Ave., Ste. 210 CHEMICAL DESCRIPTION FORM wRrr It Bakersfield, CA 93301 HAZARDOUS MATERIALS INVENTORY '~ Tel: (661) 326-3979 (One form per material, per building, or area.) ^ NEW ^ ADD ^ DELETE ^ REVISE 200 Paae1 of 2 r r w nu iTV rac~ra-ranee wr~n~r BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 Source0ne Healthcare Technologies, Inc CHEMICAL LOCATION 201 CHEMICAL LOCATION 20 4300 Ashe Road Suite 110 Bakersfield, CA 93313 CONFIDENTIAL(EPCRA) ^ Yes N FACILITY ID No. i 1 MAP No. (optionep 203 GRID NO. (optionaq 20 ' IL CHEMICAL INFORMATION CHEMICAL NAME 205 20 TRADE SECRET ^ Yes ~] No If Sub'ect to EPCRA r fer to instructions COMMON NAME 207 Kodak Developer EHS ^ Yes ^ No 20 CAS No. 209 'If EHS is "Yes," all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 21 TYPE 211 212 CURIES 21 ^ p PURE Cam MIXTURE ^ w WASTE RADIOACTIVE: ^ Yes ~] No LARGEST CONTAINER 215 PHYSICAL STATE ^ s SOLID ~ I LIQUID ^ g GAS 214 55 GAL Drum 216 FED HAZARD CATEGORIES ^ 1 FIRE ^ 2 REACTIVE ^ 3 PRESSURE RELEASE ~1 4 ACUTE HEALTH ~ 5 CHRONIC HEALTH (Check all that apply) ANNUAL WASTE 217 MAXIMUM DAILY AMOUNT 120 GAL 21g AVERAGE DAILY AMOUNT 219 CFO GAL STATE WASTE CODE 22 AMOUNT 221222 ^ UNITS ~ ga GAL ~ ^ cf CU FT ^ Ib LBS ^ to TONS DAYS ON SITE 3 65 If EHS, amou must be in lbs. 22 STORAGE CONTAINER (Check ell that apply) ^ a ABOVEGROUND TANK ^ f CAN ^ k BOX ^ p TANK WAGON ^ b UNDERGROUND TANK X[7 g CARBOY ^ I CYLINDER ^ q RAIL CAR ^ c TANK INSIDE BUILDING ^ h SILO ^ m GLASS BOTTLE ^ r OTHER ^ d STEEL DRUM ^ i FIBER DRUM ^ n PLASTIC BOTTLE ~] e PLASTIC/NONMETALLIC DRUM ^ j BAG ^ o TOTE BIN 22 STORAGE PRESSURE l~ a AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT STORAGE TEMPERATURE ~ a AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT ^ c CRYOGENIC 22 %1NT HAZARDOUS COMP,ON.ENT EHS CAS,# ' 3 226 Hydroquinone 227 ~] Yes ^ No 226 123-31-9 22 2 10 230 - 231 ^ Yes ^ No 232 23 Potassium Sulfite 10117-38-17 a 5 236 Potassium Acetate 23s ^ Yes ^ No 2ao 127-08-2 2a1 5 242 243 Yes ^ No 244 24 5 Glutaraldehyde bis (Potassium bisulfit ~ 68310-08-7 Lil. SIGNATURE PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE IGNATURE DATE 246 John Nadzan Director of EH&S ~~~ ~ 3/a:~/f~ S~ FD2086 1/" ~, UNIFIED PROGRAM INSPECTION CHECKLIST _ __ 3 E CT I O N 1: Business Plan and Inventory Program - i Prevention Services H _ E_R 5 F_,- 0 900 Truxtun Ave., Suite 210 F/RE Bakersfield, CA 93301 ARTM s . Tel.: (661) 326-3979 Fax: (661) 872-2171 . AGILITY NAME -_ ~ ~~ r~ INSPECTION DATE INSPECTION TIME _ / _ Dam/ ADDRESS HONE NO. O OFEMPLOYEES FACIL TY CO TACT y /~ BUSINESS ID NU B 15-021- ~3~/ 2 Section 1: =Business Plan er~d lnven~or`y Pcograen~ ~~~ ~. 1~~ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ( C=Compliance OPERATION V=Violation COMMENTS H~^ APPROPRIATE PERMIT ON HAND 1~ ^ BUSIfI@SS PLAN CONTACT INFORMATION ACCURATE n' EItlT'D DEC 11 20 ~'"~ ^ VISIBLE ADDRESS ~"r ^ CORRECT OCCUPANCY ,0'~ ^ VERIFICATION OF INVENTORY MATERIALS ~"'` ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OE LOCATION ~^ PROPER SEGREGATION OF MATERIAL ~^ VERIFICATION OF MSDS AVAILABILITY ~"~ ^ VERIFICATION OF HAZ MAT TRAINING ~^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~~- ^ EMERGENCY PROCEDURES ADEQUATE Bf ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARJ~DOU'~S yyWASpJTE ON SIT,E~?y „YES ^ NO EXPLAIN: ( ~`H` ~ F ~~~., - ncr-ou» QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 I~ctor (Please Print) Fire Prev tion / 1s~ In /Shift of Site/Station # Business Site / Responsible P rty (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05