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HomeMy WebLinkAboutBUSINESS PLAN 8/3/2007JAVIER CENTRAL VALLEY DENT i 1415 BRUNDAGE LANE l I _ _ .. -- --~--_---- i i _ - - - - - .I ~I JAVIER~CENTRAL VLY DENTAL CLINIC Manager MAURICE M JAVIER Location: 1415 BRUNDAGE LN City BAKERSFIELD CommCode: BFD STA 06 EPA Numb: SiteID: 015-021-003502 BusPhone: (661) 323-0076 Map 103 CommHaz Minimal Grid: 31C FacUnits: 1 AOV: SIC Code: DunnBrad:95-4733313 Emergency Contact / Title Emergency Contact / Title MAURICE JAVIER / SECRETARY RAYMOND LANCHENGIO / EMPLOYEE Business Phone: (661) 323-0076x Business Phone: (661) 323-00'76x 24-Hour Phone (818) 307-2733x 24-Hour Phoned: (661) 325-0658x Pager Phone (818) 307-2733x Pager Phone ( ) - x~, Hazmat Hazards: React Contact MAURICE M JAVIER Phone: (818) 307-2733x MailAddr: 1415 BRUNDAGE LN State: CA City BAKERSFIELD Zip 93304 Owner MA LOURDES A JAVIER DDS INC Phone: (818) 726-0531x Address 1931 W MOUNTAIN ST State: CA City GLENDALE Zip ~: 91201 Period to ,:. TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif~d: RSs: No ParcelNo: _ Emergency Directives: PROG H - HAZ WASTE GEN 0 ~ ~,~Q9 G ~N1~ ~u L3asPd on my inquiry of those individuals responsible for obtaining the infor i mat on, I certify under penalty of !aw that I have personall Qxa i y m ned and am familiar with the information submitted and belie ve the information is true, a cc urate, and complete. ' ~ Signature ~ Dat -1- 07/12/2007 l ~ F JAVIER CENTRAL VLY DENTAL CLINIC SiteID: 015-021-003502 ~ ~ 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 10.00 GAL Min -2- 07/12/2007 -3- 07/12/2007 F JAVIER CENTRAL VLY DENTAL CLINIC ~ Inventory Item 0001 SiteID: 015-021-003502 ~ Facility Unit: Fixed Containers at Site ~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 5.00 GAL 10.00 GAL 1 0.25 GAL tir~~r~tcLUUS ~vinrvlv~lv~l~ oWt. RS CAS# Silver No 7440224 rit~~Httli tiaa~~ari~iv~r~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 07/12/2007 Liquid TWaste ~ Ambient~E ~ AmbientT~E ~ PLASTOICTCONTAINERE F JAVIER CENTRAL VLY DENTAL CLINIC SiteID: 015-021-003502 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 02/05/2007 ~ EMPLOYEES TO CALL 911 AND OES AT 800-852-7550, MAURICE M JAVIER, OFFICE MANAGER TO BE NOTIFIED AT 818-307-2733. Employee Notif./Evacuation 02/27/2007 ALL EMPLOYEES TO REPORT TO DR MALOU A JAVIER AND/OR MAURICE M JAVIER, OWNERS; OWNERS TO REPORT TO HAZARDOUS WASTE MANAGEMENT CO AND AUTHORITIES. L 1.LlJ11~.. 1YV 1.11 ~ JJVQ~.. IdGl ~.1 V11 Emergency Medical Plan 02/05/2007 CALL 911 - LOCAL EMERGENCY HOSPITAL. -5- 07/12/2007 F JAVIER CENTRAL VLY DENTAL CLINIC SiteID: 015-021-003502 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 02/05/2007 ~ EVALUATION AND TRAINING WITH HAZARDOUS WASTE CO; CONTACT FOR TRAINING, STORAGE, AND PICK-UP. Release Containment 02/05/2007 REPORT ALL INCIDENTS TO RESPONSIBLE PERSONS - OWNERS - IMMEDIATELY NOTIFY HAZARDOUS WASTE CO AND AUTHORITIES. Clean Up 02/05/2007 PUT DEVELOPERS AND FIXERS IN PLASTIC CONTAINERS - ORIGINAL PACKAGING IN CASE WASTE CONTAINER LEAKS. TAKE OXYGEN AND FIRE EXTINGUISHERS OUTSIDE IN CASE OF LEAK. Other Resource Activation -6- 07/12/2007 F JAVIER CENTRAL VLY DENTAL CLINIC SiteID: 015-021-003502 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ a~~~iai nac~a.cu~ Utility Shut-Offs 02/05/2007 NATURAL GAS/PROPANE: REAR OF BLDG ELECTRICAL: REAR OF BLDG WATER: REAR YARD Fire Protec./Avail. Water 02/05/2007 PRIVATE FIRE PROTECTION: NONE FIRE HYDRANT: CHESTER & BRUNDAGE AND CHESTER & VERNAL Building Occupancy Level 02/05/2007 3 EMPLOYEES -7- 07/12/2007 _ t F JAVIER CENTRAL VLY DENTAL CLINIC SiteID: 015-021-003502 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 02/05/2007 ~ MSDS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: TRAINING MANUAL FOR ALL EMPLOYEES; ONCE EVERY YEAR LIVE PRESENTATION REGARDING OSHA COMPLIANCE. rayc ~ nc~.u ivi r u~uic u5~ n~iu ivi rul.uiC U5C -8- 07/12/2007 ~`" ` (HMMP) BAKERSFIELD FIRE DEPT. HAZARDOUS MATERIALS MANAGEMENT PLAN ~ Prevention Services ' " ` (Ut~`~IED PROGRAM CONSOLIDATED FORM) 1600 Truxtun Ave., Suite 401 _ a B R S F I n Bakersfield, CA 93301 /~1PPUC/~1~ON AAi r T Tel.: 661-326-3979 /~ BUSWESSO~VIM®2/OPB2ATORD~ITFICATIONFOFiM ~ Fay: ,661-852-2171 ~5 (HAZARDOUS MATERIALS FACILITY INFORMATION) Page 1 of 2 ~35b~- I. FACILITY IDENTIFICATION FACILnY ID NO. t Year Beginning ~~ 7 too Year Ending tot BUSINESS NAM (Same as FACILITY N E or DBA- D i Bu i ) 3 ~~{VI~IFL G~'t9%~''/1.~L. ~~L~`~~ ~>~1Y7'1~L ~(.J~'~G BUSINE PHONE toz ~olal "' ob ~ SITE A//D~~DRrESS e A y~ y~ ^~n /T !~ ~'/~'„~ l!' L~N~C/~~ 103 CITY ~a~~ 1~/l~ '°° ca IP ^~3 ~~ '°~ DUNN & BRADSTREE ~ r ~ ~ 2 '.?, ~ ~ ~ t~ .r' v SIC CODE to7 4 Digit #) COUNTY ~~~ ,A ~" ~ t~ OPERATOR NAME 9/~ ~~ ~f a~ {} ~~ V'~~SJ'f /J~l't ~?G g! g TOR PHjIONE~ ~~~~ tto i(' (IWNFR INEFIRM~TIr1N OWNER NAME 1y~, ~~md~5 ~ . ~ vj~Z. , ttt OWNER PHONE T?DS ~ r g~ ? ~ _ 6~3 ~ tt2 OWNER MAILING ADDRESS ~~ W YYlbyrn~d~h- tt3 CITY ~ ~,~ n Aa ,/r~ ~l -/~ tt4 STATE _ ` tt5 ~///-1L`ti Ip ~ ~~ ~ tte - III. ENVIRONMENTAL CONTACT CONTACT NAME ,~ l ~ /~ ~ ~"~ ~ /~I2 to CONTACT PHONE ~e~> 3a 7-- ~?3~,3 ne CONTACT MAILING ADDRESS tt9 CITY ~ `r~ ,~ ~~~I ~/~ 42.~~' /~q~ STATE ~ tzt ZIP ~~~~ ~ f yv /7/ t~ - - - - - PRIMARY iv. EIVIERiEn-cY cONracr5 -SECONDARY- NAME~~ ~ ~ ~ ~ ~ ~ ~ Y / ~~ 123 NAME ~ ; A~ ~~~ `~ I C~~i ~ !/'` C•//~ 128 TITLE S~~rc~~ 124 TITLE ~~ /~~ ~ ~ 129 BUSINESS PHONE ~ ~~ .. 6 h ~ i - U lJ !// J 125 BUSINESS ~ NE ~~ ~ O~~ ~ ( /O 130 NE 24H RQPHO ~ ~-7 126 24-HO PHON ~ ~ ~~`~ _. E 131 PAGER NO. 127 PAGER N0. 132 S ~ g~ a~? ~ ~ 7~~ ~, t 133 V. CERTIFICATION Certification: 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. SIGNATU~~O SIGNER ~ ~ 136 DAnTE 1347 NAME OF DOCUMENT PREPARER 135 NAME OF OWNER/OPERATOR (SDIG ATURE & PRINT) 137 TITLE OF OWNER/OPERATOR 138 ~~ ~, o ~~ ~,~b _ ,.~ ~„ (Hazardous Materials Facility Information - fIlVIlVIP) Business Owner/Operator Identification Please submit the Business Activities page, the Hazardous Materials Faci/itylnformation (HMMP) Business Owner/Operator Identification Form, and Hazardo~ Materials Inventory Chemical Description Form for all hazardous materials inventory submissions. For the inventory to be considered, please complete this page, it must be signed by the appropriate individual. NOTE.- The numbering ofthe instructions fo/%ws the data a%ment numbers that are on the Business Owner Operator Form page. These data a%ment numbe. are used fore%tronic submission and are the same as the numbering used in 27CCR, Appendix C the Business Section ofthe Unified Program Data Dictionary. Please numbers//pages ofyoursubmittal. This helps our CUPA orAA identi/y whether the submittal is complete and ifanypages are separated. 1 FACILITY I.D. NUMBER -This number is assigned by the CUPA or AA. This is the unique number which identifies your faaliry. 3 BUSINESS NAME -Enter the full legal-name of the business. .. r • 100 BEGINNING DATE-Enter the begihning year and date'of ttie report: ' (YYWMMDD) ~ ' ~ ` `'•~ ~ "' ~ ' 101 ENDING DATE -Enter the ending year and date of the report. (YYYYMMDD) 102 BUSINESS PHONE -Enter the phone number, area code first, and any extension ~-~ ~ . ; 103 BUSINESS SITE ADDRESS -Enter the street address where the facility is located. No post office box numbers are allowed. This information must provide a means to geographically locate the facility. 104 CITY- Enter the city or unincorporated area in which business site is located. .. ' 105 ZIP CODE -Enter the zip code of business site. The extra 4 digit zip may also be added. " • • ~ ~ 106 DUNN 8 BRADSTREET -Enter the Dunn & Bradstreet number for the facility. The Dunn & Bradstreet number may be obtained by calling (610) 882- 7748 or by intemet. 107 SIC CODE -Enter the primary Standard Industrial Classification Code number for primary business,activity.,, ,.,#-; , ; , ;.•~ NOTE.• /fcode is'more than 4 digits ieport on/y thefiistfour ~ ~ ' 108 COUNTY -Enter the county in which the business site is located. 109 BUSINESS OPERATOR NAME -Enter the name of the business operator. 110 BUSINESS OPERATOR PHONE -Enter business operator phone number, if different from business phone, area code first, and any;extension. 111 OWNER NAME -Enter name of business owner, 'rf different from business operators '• -' ~ '~ ' ' ° ~ ~ ` '~ = -' ~' 112 OWNER PHONE -Enter the business owner's phone number if different from business phone, area code first, and any extension. 113 OWNER MAILING ADDRESS -Enter the owner's mailing address if different from,business site address. , ~ , 114 OWNER CITY -Enter the name of the city for the owner's mailing address. ` ~ ' ` ~ ` ~ 115 OWNER STATE -Enter the 2 character state abbreviation for the owner's mailing address. 116 OWNER ZIP CODE -Enter the zip cede for the owner's address. The extra 4 digit zip may also be added. "• k' • ~ '~ 117 ENVIRONMENTAL CONTACT NAME -Enter the name of the person, if different from the Business Owner or Operator, who receives all environmental correspondence and will respond to enforcement activity. 118 CONTACT PHONE -Enter the phone number, if different from the Owner or Operator, at which the environmental contact can be centaded, area code first, and any extension. ~, _,• - ~ ,4 ~, _ 119 CONTACT MAILING ADDRESS -Enter the mailing address where all environmental contact correspondence should be sent, if different from the site address. '120 CITY -Enter the name of the city for the environmental contact's mailing address. 121 STATE -Enter the 2 character state abbreviation for the environmental contact's mailing address. ~ ` 122 ZIP CODE -Enter the zip code of,the,environmental contact's mailing address. The extra 4 digit zip may also be added. 123 PRIMARY EMERGENCY CONTAC`T'NAME -Enter the name of a representative that can tie contacted in case of ari emergeni:y'involving hazardou materials at the business site. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regardirn incident mitigation. 124 TITLE -Enter the the of the primary emergency contact. ~ _ v 125 BUSINESS PHONE -Enter the business number for the primary emergency contact, area code first, and any extensions. ' •'~ 126 24HOUR PHONE - Enter a 24hour phone number for the primary emergency contact. The 24-hour phone number must be one which is answered 24 hours a day. If it is not the contact's home phone number, then the service answering the phone must be able to immediately contact the individu~ stated above. : < ' • r _ 127 PAGER NUMBER -Enter the pager number for the primary emergency contact, 'rf available. 128 SECONDARY EMERGENCY CONTACT NAME -Enter the name of a secondary representative that can be centacted,in the event that the primary emergency contact is not available. The contact shall have FULL facility access, site familiarity, and authority to make decisions for the business regarding incident mitigation. _ , . .~ _ . 129 TITLE -Enter the title of the secendary,emergency contact. 130 BUSINESS PHONE-Enter the business telephone number for the secondary emergency contact, area code first, and ariy extension. 131 24HOUR PHONE - Enter a 24-hour phone number for the secondary emergency centact. The 24-hour phone number must be one which is ' answered 24 hours a day. If it is not the contact's home phone number, then the service answering the phone.must be able to immediately contact the individual stated above. - ~ - ` 132 PAGER NUMBER -Enter the pager number for the secondary emergency contact, if available. 133 ADDITIONAL LOCALLY COLLECTED INFORMATION -This space may be used for CUPA's or AA's to collect any additional information necessan to meet the requirements of their individual programs. Contact your logl agency for guidance. 134 DATE -Enter the date that the document was signed. (YYYYMMDD) 135 NAME OF THE DOCUMENT PREPARER (FULL PRINTED NAME) -Enter the full printed name of the person who prepared the inventory submittal information. 136 NAME OF DOCUMENT SIGNER (FULL PRINTED NAME) -Enter the full printed name of the person signing the page. The signer certifies to a familiarity with the information submitted and that based on the signer's inquiry of those individuals ~esponsible~for obtaining'the information, all the information submitted is true, accurate and complete. 137 SIGNATURE OF OWNER/OPERATOR/OR DESIGNATED REPRESENTATIVE -The Business Owner/Operator, or officially designated representative of the Owner/Operator, shall sign in the space provided. This signature certifies that the signer is familiar with the signer's belief that the submitted information is true, accurate and complete. .138 TITLE OF OWNER/OPERATOR/OR DESIGNATED REPRESENTATIVE (SIGNER) -Enter the title of the person signing the page. Page 2 of 2 FD 2142 (Rev. 01/07) :, ' ,1 ~ ~9 L1i'~ vim.. .~ ~ - I ~ ~ (1? ~ Q . - lel 51ne WALK (E) HOUSE i i ~ A -- -_--.._, I ~~ ~ a 1 ~ _\ ~ I ~ `' ' 1 `,~ ~ ~ ~ ~ ~ ~__ __.. B f. A ~ SOLID WALL OENOT EXTENT OF I-HOUR E~1UIP. Iii ~O ~-( ~--='--~, I OLLUPANLY S(:PAKATION WALL -INSTALL I ((('''~~~ S/tl' TVYE 'X' GVK BY?. ON BOTH SIDES OF II c ~_- RESTROOM; New oF: ExISnNG wA4L cyruDS Ic oe.l '~{{ ' Iv - ' EF IN r. Ll_EV. ~ INSTALL SOVND BAT SIN WALL ANO EXTEND GYP. pl +~ Z1 ^ - ~-- FOK UIMENSIONS~ BD. F4'UM f-LOOK SLP~ TO DELK ABOVE y T ,-.-_-.-.. _._ _.T-^,.-_~ ENETKnTIONS ~~~ AL:i ~ -~ ~~ ' _ ---"'- it ~/`~~ FIMSI-'S 'I J ~ _ I ALIGN ~:~ I , ~ I ~~ _ -- , - ~~~~[, I ul I FImSHeS _ _ -`I~ RESTROOM FILE ~ ' ~ ~ ~ ~ I -'- ~ ~~. _L_-j ° II i~ ~ -~' OP 1 0 ~°~ ~~ STERILE IL';J~ ,___ ~_ ' I I ~ ALIP~N ~ 3 :, '~ : ~ __ - - - i _-_._ I ' 0., ' HALLWAY 4. '. !._ ~ _ -- - - ~ I ~ - I ~I ®~ Q I- _~._... nuc,N_ -- -_I--- --- -- -- PT. WAfT1NG . C^., ~ t2~1 ~ ~ - _ ~ D p RECE j I i ! , S ~ ^_ ~ ~s ~~ ~ a ~I ~- , ,~ ~1- ~ ~ ~~ 0.,,. ___ ,. N ~ C' 2 I' a i OP 3~ i I I e /:,-- c~ ___ n -_ _;T f~, _ ~..e._ sO' 111 OFFICE 1---=---".- _..~.- -- -'.i I I I `~ ~ ~/ ~ ' it : I O` 1 ALIGN - ~". • . ~ ~ Va I - _ ~+ cl Fw15He5-r ~ ~` ~ ,. , i I it A \~ Vf - 1 ~_ M1. ~ I i WALL LEGEND r I ! .. ''- I -. .~ I 1- ~^~ _ l - - _ , ,. EXISTING FRa MED WALLS -' LOORDINATE WALLS r' j 5/8' MET4L STUDS n IG' OL. v/ 5/9' Gv PSUM 1~ 1 ~` BOARD tALH SIDE AND SOUND BATI INSULA LION SVI'YOKI POSrS ./ PER PLAN NOTES - E%TEND TD BOTTOM OF T-BAR ~ ~ (~ ~ {~ 00 ~ PLAN ABOVE - St: PLAN NOTES FOR BRALING 1/4" `~-~ `~ DENTAL EOUIPMFNr n SIZES AND LENGI FIS \~ ~ ~ ~ \ g ... / ~'~ / ~ ll I Feb 01 07 05:40p Linda Raphael _. ~~ ~~s E-. W W ;H O ~a J a a~ W Q . 505-764-8068 p,1 ~ ~ ~~ ~ ~ ~ ~ ~~ ~ I l g ~ a . ~ ~~ ~.~ ~ $ ~ • ~ ~ ~ ~ i ~ ~ ~~~ ~ ~r ~ g :~ q8 ~s_r 6 8S ~ Y ~ i ~" ~ ~ } ~ ~ ! ~ ~ S rr ~ ~ ~ ~ ~ ~ ~~ r a ~ ..T . ~$ ~ ~~ ~ s ~ z .' ~ .~ ~~ ~ ~ a~ .~ ~~ ~r.~a a ~ ~ .i~ ~ ~ ~~ ~ ~ ~ s ~a ~~ 3 p ~ C .~ ~ C Z0. ~ g ~ ~ ~ rS ~ _= ~3t +~r q ~ 4 ~ ~~~_ = ~~~~~ O ~~ S ~' ~~ ~I ~ ~ ~ 4 1 ~. `(,. ~ ~ fi jj ^ .~ ~ ~ ~ R ~ ~ g@ a, N ~ ~ ~ a3 ~ § ~~ ~ ~ ~ ~ ~ ~ s ~ ~ # ~~~ ~~ ~ ~ ~ ~ a - ~ - - - - ~ Y B ~ ~ ~ . ~ -- ~ ~ ~ a :~ .. _ ~ r ~ ~ ? ~ ~ ~ ~ g v _ ~ ~ ~ ? ~ ~ ~ ~ ~~ jj~ A A ~ F Y ~ S ~ ~. ~ ~ ~ ~ e ~ ~ ~ ~ ~ Y ~ g g ~ 3 ~ ~ . ~ ~ .r. ~ ~ ~ "' -- M ~~ 4 :.5.:. ~ _ ~.. .~ -- ~ - F y 7.1 ~ ~ ~ i ~ ~ K S~ ~ _ ~ ` ~L a. ~ ~ sc - ~ ~ ~ ~ k ~ ~~ ~ ~ ~ ~ ~ ~ ~ ~ g ~s ~ i= ~ ~ a . .- ~ .~ s O O O r ~~~ ~___. Feb 01 07 05:40p Linda Raphael 505-764-8068 p.2 ~~ ~~ 8 a ~ ~ ~ ~ ~ ~ ~~~ ~i $ ~ r ~~ ~ ~Z a~ s ~ ~~ _ ~~ e ~ ~~ r ~ ~ ~ . ~~~ a ~ .~ s ~ B ~ ~ ~~ - s e ~ ~ i ~ - ~ = ~~_ ~ #" ~ ~a~ ~ i ~ ~ ~ ~ ~ ~ q O ~ i ~ ~ _~ u ~' ~l ~T w-r ~• 'S'~ ~.r r~ t ^ .~ N ~ ~ ~ ~ ~ ~~ ~ ~ ~ ~~ - - a - W ~~ :~ ~ ~ ~ -- - s a ~ ~ ~~ . '~ g s ~ a i ~ ~ ~: E~ ~ ~ ~ ~ ~ ~. ~ d $ ~ ~ ~~ ' ~ ~ ~- ~ s .~ s e ~~ ~~ -- - ~ ~~ ~ ~ ~~ _~ ~ ~~ ~ .~ ~tE D{ s ~ -. ~ ~ ~ ~ ~~ ~~= ~ ~ ~a~ ~ ~ ~ r ~~~ ~ ~ ~~ ~ ~ ~ ~~ ~ $~~ ~ ~ ~~z~ ~ ~. .~ sa ~~~ ~ ~ '~$~ ~ ~ _ ~~~~ ~~ a ~~ ~ 7'.~~f~ Ys ~ ~ ~.'s .= ~ ~~s~~ ~ ~ . ~~ ~ ~ o ~~a~s~ ~s. ~ ~ ~~~ a o a ~- ~~~ ~~ Feb 01 07 05:40p Linda Raphael 505-764-8068 p.3 PirRl-PRA FIXER ,.«Y:}.........,.,...~,..........r...,.........D._..~.. _-'--- --- - -- . MSDS Product and Company Name MSDS Date: 01129/1992 MSDS Num: CKLQG Submitter: D DG Tech 05/1612000 Status A Review: CD: Product PERI-PRO FIXER MFN: 05 !D: Article: N Kit Y Part: Cage: 53542 Responsible Party Name: AIR TEGHNIQUES INC. Address: 70 CANTIAQUE ROCK ROAD City: HICKSVILLE State: NY Zip: 11801 Country: US Info Phone Number: 516-433-7676 Emergency Phone Number: 519-033-767fi Radioactive Ind: N Proprietary Ind: N Y Review Ind: Y Published: Special Project CD: Company Information Cage:53542 Name:A1R TECHNIQUES INC. Address:70 CANTIAQUE ROCK ROAD City:NICKSVILLE State:NY Zip:11801 Coantry:US Phone:516-433-7676 Item Description Item Manager: DEVELOPER ANO FIXER SET,X-RAY FILM PROCESSING Item Name: NONE NONE Specification 7ypelGradelClass: Number: PG Unit of Issue: Quantitative Expression: 1 UNKNOWN Ul Container qty: Type of Container: Ingredients Cas:7732-18~ T ZC0110000 T Code: RTECS tt: Code: Name: WATER 60. M 100. M °lo low Wt: Code: % high Code: Wt: Environmental I of 9 2J1 J2007 5:17 PA Feb 01 07 05;40p Linda Raphael 505-764-8068 p.4 rates-rntjrinnn ~~~.~:.,~..............Y.,,.., ..r,... ~.....s..,.,........,......,...,.....Y ................ ~.,,... Wt: NIP Other REC Lim its: OSHA PEL: NIP NIP Code: OSHA Cede: STEL: N1P NIP ACGIH TLV: COCIe: ACGIH Code: STEL: EPA Rpt Qty: DOT Rpt Qty: Ozone Depleting Chemical:N Cas:7783-18-8 T XN6465000 T Code: RTECS #: Code: Name:AMMONIUM THIOSULFATE 1. M 5. M low Wt: Code: % high Code: Wt: Environmental Wt: NIP Other REC Limits: OSHA PEL: {~JIP NII7 Code: OSHA Code: STEL: NIP IV/P ACGIH TLV: Code: ACGIH Code: STEL: EPA RpYQty: DOT Rpt Qty: Ozone Depleting Chemical: N Cas:7757-83-7 T Code: Name: SODIUM SULFITE 1. M low Wt: Code: WE2150000 T RTECS #: Code: 5. M high Code: Wt: Environmental Wt: NIP Other REC Limits: osHa PEL: NIP NIP Code: osHA Code: STEL: NIP NJP ACGIH TLV: Code: ACGIH Code: sr>rL: EPA Rpt Qty: DOT Rpt Qty: Ozone Depleting Chemical: N Cas:l~4-19-7 T AF1225000 T Code: RTECS #: Code: Name:ACETIC ACIp 2 of 9 2/1/2007 5:17 PM Feb 01 07 05:40p Linda Raphael 505-764-8068 p.5 PERT-ARQ'F1XER ,.«Y::,.~...,..,.,...Y.....,.,..Y.............~,•-----°------------.- - T. °t° low Wt: M Cade: 5, M high Code: Wt: Environmental osNA Pe~:25 MG/M3;10 T PPM Code: 25 MGlM3;10 T ACGIN TLV: PPM Code: 5000 LBS EPA Rpt Qty: Wt: N!P Other REC Limits: NIP OSHA Code: STEL: 37 T Acel» MGfM3;15 Cade: sTE~: PPM 5000 LBS OOT Rpt 4ty: Ozone Depleting Chemical:N Health Hazards information LD50 LC50 MixtureORAL LD50{RAT): NIP YES YES YES Route Of Entry Inds - Skin: Ingestion: Inhalation: NIP NIP NfP Carcinogenicity Inds - IARC: OSHA: NTP: Health Hazards Acute And Chronic ACUTE: EYE: IRRITATION OR BURNING MAY OCCUR. HIGH CONCENTRATIONS OF ACETIC ACID VAPORS CAN CAUSE EXCESS BLINKING, TEARING, & EYE DISCOMFORT. SKIN: IRRITATION 8 BURNING POSSIBLE. INGESTION: ACETIC ACID CAN CAUSE BURNING TO MOUTH, THROAT 8~ ESOPHAGUS. NAUSEA, VOMITING, AHDOMiNAL PAIN. SHOCK STATE COLLAPSE POSSIBLE. SODIUM SUFFITE MAY CAUSE CIRCULATORY DISTURBANCES & CENTRAL NERVOUS SYSTEM DAMAGE. INHALATION: IF HEATED AMMONIA VAPORS IRRITATE THE THROAT. CHRONIC: NONE. NONE N1P N!P First Aid EYES: FLUSH WITH WATER fOR AT LEAST 15 MINS. GET MEDICAL ATTENTION. SKIN: REMOVE CONTAMINATED CLOTHING & WASH SKIN THOROUGHLY WITH SOAP 8~ WATER. WASH CLOTHES BEFORE RE-USE. INHALATION: REMOVE TO FRESH AIR. iF BREATHING BEGOMES DIFFICULT, GIVE OXYGEN, GET MEDICAL Explanation Of Carcinogenicity Signs And Symptions Of Overexposure Medico! Gond Aggravated By Exposure 3 of 9 2/1/2007 5:17 P1V Feb 01 07 05:41 p Linda Raphael 505-764-8068 p.6 PERT-PRO'F17~ER nnp:~~www.cu»~pi~ai~ucNuv~r~..,,.~,....,,.,,...~..,..,,...,..w,...r.........-.-.- a-_.. ATTENTION. INGESTION: IF GONSCIOUS, GIVE LARGE AMOUNTS OF WATER. DO NOT INDUCE VOMITING. IF NOT CONSCIOUS, GIVE ARTIFICIAL RESPIRATION. O STAIN PROMPT MEDICAL ATTENTION. Spill Release Procedures NEUTRALIZE WITH SODIUM BICARBONATE, DIKE THE SPILL AND SOAK UP WITH ABSORBENT MATERIAL. PUT INTO PLASTIC CONTAINER FOR LEGAL DISPOSAL. SODIUM BICARBONATE. Neutralizing Agent Waste Disposal Methods DISPOSAL MUST CONFIRM TO FEDERAL AND LOCAL REGULATIONS. CONSULT LOCAL SEWER AUTHORITY. Handling And Storage Precautions STORE & HANDLE IN A TIGHTLY CAPPED CONTAINER. WEAR PROTECTIVE GLOVES, CLOTHER, & GOGGLES. KEEP WORK SPACE UNCLUTTERED. AVOID CONTAGT WITH EYES & SKIN. STORAGE: DO NOT STORE NEAR FOOD, DRINK, OR TOBAG CO PRODUCTS. STORE IN A WELL VENTILATED AREA. STORE Bt=TWEEN 10 TO 25 DEG C. DO Nfl-f' ALLOW TO FREEZE. Other Precautions SNIP ABOVE 4.4 DEG C. PROTECT FROM PUNCTURING BY HANDLING OR OTHER EQUIPMENT. Fire and Explosion Hazard information Flash Point N/A Method: Flash Point: Autoignition Temp: NIA Lower Limits: NIA Flash Point Text: N/A Autoignition Temp Text: NIA Ugper Limits: Extinguishing Media ANY APPLICABLE TO THE PRIMARY CAUSE OF FIRE. Fire Fighting Procedures FIREFIGHTERS SHOULD WEAR SELF CONTAINED 6REATHiNG APPARATUS. EXCESSIVE BEAT MAY CAUSE THE PRODUCTION OF HAZARDOUS DEGOMPOTITION PRODUCTS. NIP Unusual FirelExplosion Hazard 4 of 9 2/1/2007 S:17 PiV Feb 01 07 05:41 p PERI-PRO FiXI/K T, Linda Raphael 505-764-8068 p.7 ilu~tCrrwww.a.vuc~..r... .,t.....u~.,...b .................~....,.... -r'.......'----- a--~-- Control Measures Respiratory Protection USE NIOSH APPROVED CARTRIDGE RESPIRATOR IN POORLY VENTILATED AREAS_ Ventilation RECOMMENDED VENTILATION -10 ROOM VOLUMES PER HOUR. Protective Gloves NITRILE RUBBER OR PLASTIC. Eye Protection CHEMICAL SPLASH GOGGLES. Other Protective Equipment EYE WASH STATION. NIP Work Hygienic Practices Supplemental Safety and Health ITEM IS A DEVELOPER AND FIXER SET FOR X-RAY FILM PROCESSING; CONTAINS 3 QUARTS OF DEVELOPER AND 3 QUARTS OF FIXER USED IN DENTAL AUTOMATIC PROCESSING. Physical and Chemical Properties HCC:T4 NRC1State LIC No: Net Prop WT For Ammo: >100.C, Boiling Point:212.F B.P. Text: =O.C,32.F McItlFreeze Pt: M.P/F.P Text: NIP Decomp Temp: Decomp Text: NIA NIA Vapor Pres: Vapor Density: 1,1 Volatile Org Content Spec Gravity: VOC PoundslGallon: 4.5 TO 5.0 PH 5 of 9 2!7 /2007 5:17 Plv Feb 01 07 05:41 p Linda Raphael PERT-PRO~FIXER . 505-764-8068 p.8 l1LL~l;J/ »' W n.Vw~~r~iwav..,..»v....,,...b ......... ~.,-° --- _...._..r -- - -' NIP VOC GramslLiter: Viscosity: N/A Evaporation Rate & . Reference: COMPLETE Solubility in Water: VINEGAR ODflR> CLEAR COLORLESS Appearance and LIQUID Odor: NIP NIP Percent Volatiles by Corrosion Volume: Rate: Reactivity Information Stability Indicator:YES NlP Stability Condition To Avoid: STRONG ALKALIS OR ACIDS. WILL Materials To Avoid: NEUTRALIZE STRONG ALKALIS AND RELEASE SOME HEAT. SULFUR DIOXIDE (ACIDS)'AND Hazardous AMMONIA (ALKALIS). Decomposition Products: NIP Hazardous Polymerization Indicator: N/P Conditions To Avoid Potymerizatio n: Toxicological Information ToxicoloaicalAMMONlUM THIOSULFATE: ORAL/RAT lnformation:2$90 MGlKG. SODIUM SULFITE: IVN/RAT 115 MGlKG. ACETIC ACID: ORAURAT 3310 MG/KG. LC50 5620 PPM 1 HR. MOUSE. HM1S Transportafion Information Responsible Party 53542 Cage: PERI-PRO FIXER ProductlD: 01/29/1992 MSD5 Prepared Date: 5 MFN: 153015 Trans. ID NO: 05116!2000 Review Date• D DG A Submitter: Status CD: N .CONTAINS Article WIO Tech Entry NOSITYDROQUINONE. MSDS: Shipping Nm: Radioactivity: Form: Net Explosive 6 of 9 2!1!2007 S: l7 Ply Feb 01 07 05:41 p Linda Raphael 505-764-8068 p.9 PERT-PRC}FIXER ~ uta~iL~i yr yr n.i.v„ay„w,....y .............b••••,~••• •••••----' ----"r------' - - v Weight: Coast Guard AMMO Magnetism; Code: 6.9 Net Unit Weight:LBS AF MMAC Code: N DOD Exemption NUM: Limited Quantity IND: 0 N Multiple KIT Number: Kit IND: Y Y Kit Part IND: Review IND: PG 1 Unit Of Issue: Container QTY: UNKNOWN Type Of Container: UNIT OF 4SSUE CONTAINS 3 QUARTS Additional Data: pEVELOPER; 3 QUARTS FIXER. DoT DOT PSN Code:QKO G Symbols : TOXIC LIQUIDS, ORGANIC, N.O.S. DOT Proper Shipping Name: DOT PSN Modifier: 6.1 UN21310 Hazard Class: UN ID Num: III DOT Packaging Group: KEEP AWAY FROM FOOD Label: T7 Special Provision: 153 Packaging Exception: 203 241 Non Bulk Pack: Bulk Pack: 60 L 220 L Max Qty Pass: Max Qty Cargo: A Vessel Stow Req: 40 Water/ShiplOther Req: tM0 IMO PSN Code:OTX TOXIC LIQUID, ORGANIC, N.O.S. o IMO Proper Shipping Name: 1M0 PSN Modifier: 7 of 9 2112007 5:17 PiV Feb 01 07 05:41 p Linda Raphael PER i-PR(YY'1X k.x r ~ 6270-1 IMl~G Page Number: 6.1 UN Hazard Class: Subsidiary Risk Label: 6:1-02 EMS Number: 505-764-8068 p.10 uu~iC~~rrrrr.~+v..•Yuw•..t........~.....b.-...... _...-~_.-_.'__r-________ ~ 2a1o UN Number: 1/111111 IMO Packaging Group; T MED First Aid Guide NUM: IATA IATA PSN Code: YIF 2810 IATA UN ID NUM: TOXIC LIQUID, ORGANIC, N.O.S. " IATA Proper Shipping Name; IATA PSN Modifier: 6.9 IATA IJN Class: Subsidiary Risk Class; Toxic IATA Labet: IN UN Packing Group: 60L Max Quant Pass: 616 611 Packing Note Passenger: 220E Max Quant Cargo: Packaging Note Cargo: Exceptions: AFI AFI PSN Code:YGG AFI Symbols: AFI Proper ShippingTOXIC LIQUID, ORGANIC, N.O.S. Name: AFI PSN Modifier: AFI Hazard Class:6'1 AFI UN ID NUM:UN2810 AFI Packing Group:III AFI Label: Special Provisions: P5 Back PackA10.5 Reference: 8 of9 2/1/20Q7 5:17 PN Feb 01 07 05:42p Yr~xi-rKU N v~K Linda Raphael 505-764-8068 `" ~~~a1.I.~r n ~r n.~.v.,.Y.wa~w~.u......,.....t,......... 1VtS~S Hazcom Label Product ID: PERT-PRO FIXER 53542 N Cage: Assigned IND: CompanyAlR TECHNIQUES INC. Name: 70 CANTIAQUE ROCK ROAD Street: PO Box: City: HlCKSVILLE NY 19801 State: Zipcode: US Country: Health Emergency Phone: 519-433-7676 Label RequiredY 05/1612000 IND: Date Of Label Review: A Status Code: Label Date: Origination F Code: YES Eye Protection 1Nt7: CAUTION Signal Word: Health Hazard: Slight Slight Contact Hazard: Fire Hazard: None None .Reactivity Hazard: MFG Label NO: Year Procured: N1P Chronic Hazard IND: YES Skin Protection fND: YE5 Respiratory Protection IND: Hazard And Precautions ACUTE: EYE: IRRITATION OR BURNING MAY OCCUR. HIGH CONCENTRATIONS OF ACETIC ACI©VAPORS CAN CAUSE EXCESS BLINKING, TEARING, 8~ EYE DISCOMFORT. SKIN: IRRITATION ~ BURNING POSSIBLE. INGESTION: ACETIC ACID CAN CAUSE BURNING TO MOUTH, TI-IROAT S ESOPHAGUS. NAUSEA, VOMITING, ABQOMINAL PAIN. SHOCK STATE COLLAPSE POSSIBLE. SODIUM SUFFITE MAY CAUSE CIRCULATORY DISTURBANCES 8~ CENTRAL NERVOUS SYSTEM DAMAGE. INH ALATION: IF HEATED AMMONIA VAPORS IRRITATE THE THROAT. CHRONIC: NONE. p.11 9 of 9 2/1120D7 S: Z 7 P?~ Feb~01 07 05:220 Linda Raphael - ~2-=- '~ --- _.. 505-764-8068 p.2 ~~~ Acconntl Site # ! • ! 5tericycie •.~ STERI•SAfE¢M SERYICEAGREEMEfIrT Name: Address 1: Address 7i Cibrl5late/Zip E-Mai . Phone: contact: ice address 2~.1L&CCpnr~al Valley Dgntal Clihjc j,415 Brundagg{,~~` Bakersfield Califarnia_93304 t~ 3~-0~76 c~ t• Fax: [~) ~-~.~? Ti lt~e•. Marne: Address. l• A ss 2: CitvlStatelZip• E_~aii: o e• on 8iliirlgAddress (If Di rent) (^) ~ ext. ~- t31 X4.7..-~dfi Maurice ]avler Tide: Qf~ce N~ n~ oast The parties agree as follows: 1. The Effective date of this agreement iS Qa/Q,~,J~oo7. 2. S4ericyde shall remove and dispose of Customer's Regulated Medical Waste (Hazardous Waste as applicable} subject to the terms and conditions set forth below. 3. Steriryde will provide additional compliance services for the prices appAdble to the serv-ce program level Gustomer has selected faebw. STERI-SAFE *Additional Waste Services Steri-safe Program kevei Pr err ~{~Orv~ncluded w! 55 Trans. Ct~aroe 3/Coat Payment Schedule: Billed Quarterly at the rate of Detrtal Waste ®YES #158.30 SPer N~antftl ^ YES Pharm ` rsonthry payment sdiedufe only ave7Wde for stlacted Programs w1m PAP h'e9~XV g~eaeer than Chemo/Pates ^ X&S 13 pidaps per t'eat'. Service Frequency 4 (E~rgrv 12 Wee } Additional Pirlr Up Charge $~4.Q0 Medical Waste Container Size (Far snips N addition Ooyaur regttWr sQteduieJ Each additional Container Charge $ X5.00 Maximuvn Medical WasTae Containers per Pickup 4 Medical Waste Committer Size Metlium * Not available in alt areas. Each Additional Container Change $ 35.00 1 acknowledge that I am or agent and that I have the authority tD hihp Customer to eustoneer agrees to he boesnC by the berms and conditions that appeac on the second page herOtsF atld comply with Stericy~de's waste Acceptance t~olicy, lath of which are ineagtat parts oFthis Aq tnent. CUSTOM[-R: X ~~} MEASE PRINT': ~~9/y12Z« Vol ~I S,~.t~,~7tJ~'t'~ pate: oT_7 _L~~ STE[t;ICyCLE: x PLEASE PRIIiiT:_4nda Raphael Title Healthcare CompNan Reu _ Date: ONLY Type of Agreement Syr Term of agreement ~ i'honths Tax Exempt ^ YES ^ NO If YES, 1D# (copy must accompany paperwork} romp Cade Purchase arrier (if applicable} # From ,_,._J.~J to _/r/ Segment Code ENi Affiliation Code SFI?C Record #x634 2 Routing_Ltformation (Operations Denattmentl• Med Waste Container Code T821 Qty Special Waste Coma+ner Code Qty None (sharps only} ^ Service Ama FR5052 Route # ~ Corrtainer Setup Date „_,_/_/2007 First Pickup Date {Cyde i3egin Date) ~/~.J20o7 Day of Service: ~ Mon ^ Tues ^ Wed ®Thuts ^ Fri Service Hours &5 Monday-Friday Routing CammenLs Stericytcte, Inc. • wvvw.stericycle.wrn •28161 N, 1Ce'ith Drive. Lake Forest. IL 60045 • P (~3 78-479 • F (~ The offer WiU Expire on;Q2J0512007 1/11/2007 CA-011107NS~ __ _ eb 01 07 05:26p Linda Raphael 505-764-8068 p,7 ;~~-- ~ . ~ ~. • •! + i~ Stericycle~ DENTAL 1NASTE CUSTOMER RROFfLE CUSTOMER NAME: Javier Central Vatley Dental Clinic ACCOUNT # EPA # REFERRED BY: SERVICE ADDRESS STREET: 1413 Brundage Lane CITY Bakersfield STATE: CA 21P: 93304 SERVICE CONTACT: Maurice PHONE: 661-323-0076 SERVICE HOURS; 9-5 M-F LUNCH; Open SERVICE t3 26 (tz4 6 4 2 FREQUENCY: ^ (1x2wks} ^ wks) ^ {fxBwks) ® {1xt2wks) ^ (1x24wks) SPECIAL PICKUP INSTRUCTIONS: CHECKAPPROPRIATE 80X FIXER AND DEVELOPER VAPO-STERIL® GLUTARALDEHYDE {2.7% OR HIGHER} LEAD FILM BACKING MERCURY AMALGAM AMALGAM PAILS """ # OF 5 GAL OTHER CONTAINERS 0-4 SIZE ® # OF 5 GAL CONTAINERS 0-4 #OF5GAL CONTAINERS 0-4 # OF 1 GAL CONTAINERS 0-4 ® # Of= 1 QT CONTAINERS 0-4 '*Additional Disposal ^ # OF 5 GAL Fee Applies for this CONTAINERS Container SALESPERSON Linda Ra hael EFFECTIVE DATE OF CONTRACT: 02101(2007 STERICYCLE, INC. 2775 East 26'" Street • Vernon, California 90023 z- , -_., V D~ ,~ F JAVIER CENTRAL VLY DENTAL CLINIC ~ SiteID: 015-021-003502 Manager MAURICE M JAVIER Location: 1415 BRUNDAGE LN City BAKERSFIELD BusPhone: (661) 323-0076 Map 103 CommHaz Minimal Grid: 31C FacUnits: 1 AOV: CommCode: BFD STA 06 EPA Numb: SIC Code:. DunnBrad:95-4733313 Emergency Contact / Title Emergency Contact / Title i MAURICE JAVIER / SECRETARY RAYMOND LANCHENGIO / EMPLOYEE Business Phone: (661) 323-0076x Business Phone: (661) 323-0076x 24-Hour Phone (818) 307-2733x 24-Hour Phone (661) 325-0658x Pager Phone (818) 307-2733x Pager Phone ( ) - x Hazmat Hazards: React Contact MAURICE M JAVIER Phone: (818) 307-2733x MailAddr: 1415 BRUNDAGE LN State: CA City BAKERSFIELD Zip 93304 Owner MA LOURDES A JAVIER DDS INC Phone: (818) 726-0531x Address 1931 W MOUNTAIN ST State: CA City GLENDALE Zip 91201 Period to TotalASTs: = Gal Preparers TotalUSTs: _ ,Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN Based on my inquir responsible for obtaining the information under I r _ ENT'D ~ ~ ~ ~ b =l°7 ~~ , certify penalty of law that I h U/ ave examined and am familiar with th s b n ln u e i formatio mitted and believe the inform ac ti a on is 4ru2, curate, and complete. ~~/~ ~ 7 ~d 7 Signature Date -1- 02/05/2007 ' ~ i _^', F JAVIER CENTRAL VLY DENTAL CLINIC SiteID: 015-021-003502 ~ ~ 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 10.00 GAL Min -2- 02/05/2007 ~- s -3- 02/05/2007 F JAVIER CENTRAL VLY DENTAL CLINIC SiteID: 015-021-003502 ~ ~ 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: CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TWaste -~mbient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 10.00 GAL 0.25 GAL riAGHKLVV~ 1:V1~lYV1VI;1V1'S ~Wt. RS CAS# Silver No 7440224 H1iGL-1KL H~at5551~1LN'1~~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 02/05/2007 F JAVIER CENTRAL VLY DENTAL CLINIC SiteID: 015-021-003502 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 02/05/2007 ~ EMPLOYEES TO CALL 911 AND OES AT 800-852-7550, MAURICE M JAVIER, OFFICE MANAGER TO BE NOTIFIED AT 818-307-2733. Employee Notif./Evacuation a 02/05/2007 r (~ ALL EMPLOYEES TO REPORT TO DR MALOIV A JAVIER AND/OR MAURICE M JAVIER, OWNERS; OWNERS TO REPORT TO HAZARDOUS WASTE MANAGEMENT CO AND AUTHORITIES t I.LLl11V 1YV {~11 ~ L' VRVI.LGlL1Vli Emergency Medical Plan 02/05/2007 CALL 911 - LOCAL EMERGENCY HOSPITAL. -5- 02/05/2007 F JAVIER CENTRAL VLY DENTAL CLINIC SiteID: 015-021-003502 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 02/05/2007 ~ EVALUATION AND TRAINING WITH HAZARDOUS WASTE CO; CONTACT FOR TRAINING, STORAGE, AND PICK-UP. Release Containment 02/05/2007 REPORT ALL INCIDENTS TO RESPONSIBLE PERSONS - OWNERS - IMMEDIATELY NOTIFY HAZARDOUS WASTE CO AND AUTHORITIES. Clean Up 02/05/2007 PUT DEVELOPERS AND FIXERS IN PLASTIC CONTAINERS - ORIGINAL PACKAGING IN CASE WASTE CONTAINER LEAKS. TAKE OXYGEN AND FIRE EXTINGUISHERS OUTSIDE IN CASE OF LEAK. v~.iici. iccavui~,c t"11.1.1VQ1.1V11 -6- 02/05/2007 F JAVIER CENTRAL VLY DENTAL CLINIC SiteID: 015-021-003502 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ Utility Shut-Offs 02/05/2007 ,NATURAL GAS/PROPANE: REAR OF BLDG ELECTRICAL: REAR OF BLDG WATER: REAR YARD Fire Protec./Avail. Water PRIVATE FIRE PROTECTION: NONE FIRE HYDRANT: CHESTER & BRUNDAGE AND CHESTER & VERNAL 02/05/2007 Building Occupancy Level 02/05/2007 3 EMPLOYEES -7- 02/05/2007 t~ F JAVIER CENTRAL VLY DENTAL CLINIC SiteID: 015-021-003502 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 02/05/2007 ~ MSDS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: TRAINING MANUAL FOR ALL EMPLOYEES; ONCE EVERY YEAR LIVE PRESENTATION REGARDING OSHA COMPLIANCE. rays a iac s.u tvt r l1 l.UtC 1J .7-C I1C 11..1 1VL 1'UI.UiC USf.' -g- 02/05/2007 ~~i ~. Sullivan-Schein Dental _ -: _ ,_ ArHEN12YSCHETI~'~COMf'ANY2654206-O1~ 1/18/07 1216661-001 1 EZ2001115200701 7 of 12 J BOX CONTENT LIST HMA LOURDES JAVIER BMA LOURDES JAVIER 1 L P1415 BRUNDAGE LN L 1415 BRUNDAGE LN T T ~BAKERSFIELD CA 93304-3114 ~ BARERSFIELD,CA 93304-3114 .LOCATION SHIPPED EXP. UNIT ~ LINE' CODE QTY CODE SIZE DESCRIPTION & STRENGTH ffEM CODE NO. .MS-DS 1 EA CRASH CRT&DEMND,VALV MSDS OXYGEN 105-.2675 81 SIILLIV -SCHEIN DENTAL 255..VIS A BLVD. SPARKS, NV 89434 I .. .:. OFFICE USE ONLY eATCH# 4~2 91.5 - 0 0 ~ ~ S Z !r ~r i 7T 5 YY y - ~ FREIGHT INSTRUCTIONS 8- 0 4 2 0 6 RETURNS NFORN9ATIOA' i. Every effort has been made to assemble and pack your order with exacting care. If there is a problem with your order, we would like to rectify it and make sure you are completely satisfied tivith the result. BEFORE RETURNING - Expiration Date Problems: Double check the date because same dates stamped on merchandise are the date of manufacture, not expiration. FOR QUICK RETURN PROCESSING - How to Package: Please use the original shipping carton or strong corrugated carton and adequately cushion the products to prevent damage during shipping. - Equipment & Nandpieces: Used equipment and handpieces may net be returned for credit but will be repaired or replaced in accordance with the manufacturers' tivarranty. - Dental Alloy & Gald: These products may not be retumed. - Hazardous Materials: Please call for special handling instructions. Special Ordered Items: These products may not be returned - Questions: Please call: Dental 1-800-372-4346 (8am - 7pm et} Medical 1-800-772-4346 (8am - 7pm et) Veterinary 1-800-872-4346 (8am - 7pm et} Dental Institutional 1-800-851-0400 (8am - 6pm et} Medical Institutional 1-800-972-2611 (8am - 6pm et} ProRepair 1-800-367-3674 (8am - 9pm et} ACCOUNT INFORMATION (Please Print} Documentation: Please include the packing list with the return information clearly filled out. This will help to process your return promptly and accurately. We use the reason code information to help us prevent future problems. (AI1 controlled substances require a Return Authorization) - Shipping Address: Please use the label below on the carton being returned. - Insurance: For your protection, please insure your return. - Returns on specific items (as indicated in the catalog Terms of Sale} are subjected to a restocking fee. CUSTOMER NUMBER RETURN INVOICE NUMBER R ITEM CODE QUANTITY DESCRIPTION REASON E _ T U - R N - I _ N G - COMMENTS: Because vre value you as customer, any comments you may have would be appreciated. ~SULUVAN-SCHEIN DENTAL ~ 41 WEAVER ROAD DENVER, PA 17517 ~ATTN: RETURNS DEPT. i I THANK YOU FOR LETTING US SERVE YOUR NEEDS ,. M a t e r i a l OZYGEN Mada Medical Products, Inc. 60 Coffinerce Road Carlstadt, N.J. 07072 Safety Data. Sheet Page: 1 Telephone: (201) 460-0454" Eaerg~ncy Contact : Jeff Adam Emergency Phone Number: (800) 526-6370 SZCTION ~ 1 - IDSZQTIlIC71TZON Product: OXYGEN CAS Number: 7782-44-7 Product Cede: t~SDs CODE G-1 Chemical Family: Oxidizer Chemical Fotznula: 02 Synonyms: G-1 NFPA FIa~ard Rating - Health: 3 Hi h - Fire: o Negligible - Reactivity: 0 Hogligihla - Special: Oxy 6ECTZON ~2 .. C88XZCAL COI~IPO~tL'NT$ Component: OXYGEN CAS Number: 7782-44-7 Percent of Mixture: 99.6000 to 100.0000 j 8ECT202i ~3 ~ 4'NYSZG-L Df-TA~ Boiling Point: -297.3'g - 182.9'C Melting Point: - 361.8•F - 218.8'C Vapor Pressure: 7-bove critical temp. Specific Gravity: 1.11 ( ds, air=i.o) Solubility (H20): Slightly soluble Appearance Colozless gas. M a t e r i a l OZYGEN s a tat y D a t e S h e e t l BECTZON #3 - PHYSICAL DATA Cantinuad... Odor Odorless. SECTIOrT iii - F11tE PIGBTING i EZYIABZCN DATA Flash Point: N/A Lover Explosive Limit {t}: NJA Upper Explosive Limit (~): N/A Fire and Explosion Sazards Electrical Classification: Nonhazardous Vigorously accelerates coabustion. Extinguishing Diedia Page: 2 Cocious quantities of Water (or the suitable extinguishing agent for the cozL:ustible materia1l for fires with oxygen as the oxidizer. Special Fire Fighting Instructions If possible, stop the fiov of oxygen which is supporting the fire. BECTICN #S.- EaPOSURE snd EFFECTS - IH$ALATZOri Routes of Exposure -.Zahalation Higr. concentrations (greater than 75~} causes symptoms of hyperaxia which inclu~ed cramps, nauQea, dizziness, hypothermia, a~ lopia, respiration difficulties, bradtcatrdia, fainting spells and eonvu~sions capable of leading to death. The property is that of hyperoxia which leads to pntux~criia• concertzations between 25 an 75 percent present a risk of inflammation of organic taatter in the body. First Aid - Inhalation FROM'P?` MEDICAL ATT~...NTION ZS 1KANDATORY ZId ALL CASES OF OVEREXPOSVRF TO OXYG£:1. RESCUE PERSONNEL SIiOIILD BE EQUIPPED WITH SELF-CONTAINED BREATHING APPARA:OS. M a t e r i a l S a f e t y D a t a S h e e t Page ~ 3 OZYGEN SECTION ~S - EZPOBIIRE and Epp8CT8 - 2N8]-LATIOK Coatinuad... First Aid - inhalation Victims should be assisted to an uncontaminated area and inhale fresh air. Quick xemoval from the contaminated area is most important. Unconscious persons should be moved to an uncontaminated area, and if breathing has stopped, administer artificial resuscitation and supplemental oxygen.. Further treatment should be symptomatic and supportive. The physician shoulfl be informed that the victi3a Could be experiencing hyperoxia. 8ECTIaN • s - EZpO8II1tE atad EFFECTS 8EI2t Routes of Exposure - Skin Contact with liquid product may cause tissue freezing. First P.id - skin For dermal contact oz' frostbite: Aemove contaminated clothing an3 flush affected areas with lukewarm water. DO NOT USE HOT WATER. A physician shoulc't sae the patient promptly if the cryogenic "burn" has resulted in blistering of the dermal surface ar deep tissue freezing. SECTIO~i +~b - tZP06IIRE snd EFFEC'PS - BYES ~toutes of Exposure - Eyes Contact with liquid product may cause tissue freezing. First Aid - Eyes Never introduce ointment or oil into the eyes without medical advice! +n case of freezing or cryogenic "burns" caused by rapidly evaporating liquid, no NOT WASH T~iE EYES WSTH HOT OR EVEN TEPID WATER! Remove victim from the source of contamination. Open eyelids wide to allow liquid to evaporate. If pain is present, rater the victim to an opthalaologist for treatment and follow up. If the victim cannot tolerate light, protect the eyes with a liclht bandagQ. C BLCTZON 1S - 1'[ZHCELI.AXEOCB TOZICO2.aG2CalI. I2~FORMATI02t Carcinogenicity: NTP - No IARG - No OSHA - No Material Safety Data Sheet Page: a OZYCEN I SEGTZOtd ~6 - AE7ICTZQITY i POLYliER2Z]1TZON `Stability: Stable Canditians to Avoid (Stability) Contact with all flammable materials. Zncampatible Materials Ali flammable materials. Hazardous Polymerization: Will Not Occur SECTION ~7 - HPILL, LE7hlC, i DZ9POBl1Z PRbCZDt?RZ8 _._ _~ Steps to be TakEn in The Event of Spills, Leak.~s, or Release Stationary customer site vessels should operate in accordance with the saanufacturer's ~ instruction. Do not attempt to repair, adjust or in any other way modify the operation of these vessels. If there is a malfunction or other type of aperntions problem with the vessel, contact the closest location immediately. Waste Disposal Methods De not attempt to dispose of waste oz unused quantities. Return in the shipping container PROPERLY LABET.ED, WITH ANY vAL~rE OUTLET PLUGS OR GAPS SECURED AND VALVE PROTE~'ION CAP IN .PLACE to Airco for praper disposal. SARA Hazard Classes: Fire Hazard Sudden Release of Pressure Hazard 8$CTSObi ~8 - SPECIAL PROTECTI'TE liEASQRES i ventilation Use local exhaust to prevent accumulation of high concentrations that increase the oxygen level in air to more than 252. ~yQ Protectien Safety-goggles or glasses plus a face shield. l u 1 r M a t e r i a l S a f e t y D a t a. S h e e t -- ~ Page: s OZYGEN 1 BECTIOId i8 - SPECIAL PROTECTIVE HEASIIRES Coatiatied... SXln Pz'otectiOn Loose fitting and insulated. other Protection Safety shoes, safety shower. SECTION ~9 - SPECIAL PA2CAIJTIONB - STORAGE i E1~NDLING Storage t Handling Canditions L'se only in yell-ventilated areas. Valve protection caps must remain in place unless cantai:~er is secsrez with valve outlet piped to use point. Do not drag, slide or roll cylinders. Use a suitable hand truck for cylinder aabvement. Use a pressure reducing regulator when connecting cylinder to lo~.e: pressuze (<3000 psig) piping or systems. Do not heat cylinder by ary means to increase t~:e discharge rate of product from the cylinder. Use a check valve or trap in the d~.scharge line to preve:it hazardous back flew into the sys~em. Protect cylinders froze p;~ysical_damage. store in coal, dry, well-ventil~-ted area awal• from heavily.trafflcked areas and exaergency exits. Do net allau the teaperature where cylinders are stared to exceed I3o•F {54•C}.~~Cylinders should be stored upright and firmly secured to prevent falling or beinr~ knocked over- full and e~apty cylinders should be segregated. Use a "first in-first ost" inventarX system to prevent .full cylinders being stored for excessive periods ~of tlme. Post "NO SMOKING OR OPEN FLAMES" signs iri they storage area ar use area. There should be no s:,srces .of ignition in the storage or use area. for additional storage recommendations, consult Compressed Gas Assoeiatien's Pamphlets P-1, P''!4, and safety belle*_in SH-2. Never carry a compressed gas cylinder or a container of a gas in cryogenic liquid form in an enc:osed space suc*: as a car trunk, van or station wagan. leak can result in a fire, explosion, asphyxiation or a toxic exposure. r 8PCT20~1 ~ t0 - B2iSPp2NG INpoRM]-T2CH Froper Shipping Name: oxygen or Oxygen, Compressed Hazard Class: Nonflammable Gas DOT Ideritific:ation Nu~Er: UN1072 DoT Shipping Label: oxidizer ~- ~~ ,. ,t, M~ a t e r i: 1 s a Z e t y D n t a S h e e t Page : ~. OZYGEl~t 1 azcT2ox #i0 ~ 8HZ?F2NG 2i~i4o8x1-TZOx Continued... ___. aECTZOx #it - 1iI8c Co?IISEatTa a R~`?LRL'biCB DoCC~2~T]lTtost - . Carbon steels and low alloy steels art aecieptabie for use at ].over pressures. For high rsssurs applications stainitss steals are ac~eptabl• as ars copper and its alloys, rickal and its alloys, brass bronze, silicon alloys,. Konel {Ri, Znconel (R) and bsrylliu~. Lead and silvEr or land tin allo s ars good gasket materials. Teflon (R), Teflon (R) composites, or Kel-F (R~ sre preferred nor.-metallic gasket materials. c2zec7c with the supplisr to verify ox.-gen compatibility -for the sarvics conditions. - For additional storage recommendntions,'cotisult Compressed Gas 1-ssocintion's Pam~lets P-1, P-i4 and G-4. - - - oxy~en should not be used as a substitute-!err compressed nix in pneumatfc tqu_pment since-tAis type generally contains tlamm,able lubricants•.Equipment to rantain oxygen must be "cleaned !or oxygen cerviea," Compressed gas vessels should not be refilled excerpt by qu:1if3cd prad~~cers vt coapsesstd oases. Shipment o~ a compressed gas vezsel which has not been filled by the oti-ner or'w~th his (Written] consent is a violation of Fad4ral Law (49C:R~-. 92SCL~R o! E2PREa8ZD 71MD 71[PLIEa .T2Z$ Althcugh ressanabls cars has been taken in the ~raparation of this document, ve axtsnd no warranties and make rto repre~sentatxons as to the accuracy or completeness or the fntoraation•eontained•therein, and asRUme ra responsibility resardinq thQ suitability of this information for the user's intended gu:posas or for t.'~e consecrvencas of its use. Each individual should maJca a datarmination as to the suitability of the f.nformation for their particular purgase (s) .