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HomeMy WebLinkAboutBUSINESS PLAN 7/16/2007 M b d N @'~ ~' a W .. ~ _ _.~ IMAGE DENTISTRY SitelD: 015-021-002229 ~G l tSCi+'EN M t~ Manager :, DEBBIE K-I~~i~i~N BusPhone: (661) 322-8860 Location: 1801 26TH ST Map 102 CommHaz Minimal City BAKERSFIELD Grid: 25B FacUnits: 1 AOV: CommCode: BFD STA O1 SIC Code:8021 EPA,~Numb ; . DunnBrad Emergency Contact / Title Emergency Contact / Title M A GHALAMBOR DDS / OWNER / Business Phone: (661) 322-8860x Business Phone: ( ) - x 24-Hour Phone (3io ) `i"1~ =3~~x 24-Hour Phone ( ) - x Pager Phone (6~3-) 3'~~~- Pager Phone ( ) - x Hazmat Hazards: React Corrt-ae t----. - H-GHALAMBOR - -- -- -- Phone : ('661)-32 2~= 8 8 6 0 x MailAddr: 1801 26TH ST State: CA City BAKERSFIELD Zip 93301 Owner M A GHALAMBOR DDS Phone: (661) 322-8860x Address 1801 26TH ST State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ~~ `1~~ ~ 8 ZO07' OaCed on my inquiry of those individur~is respon~i,~le for o~,taininp t A e .t_ .~>_ .._~- - ~,f.,~r.....:~__ . _ - er-p~n~al,y° o~av~r that I hav e e xamined and am famiiiar with the nfo matori submitted and beii eve the information is true, accurate, and complete, Sigr atur~~~~~~ -- ~ ~P `O~7 ` Date -1- 07/12/2007 +~NEWt~IMAGE DENTISTRY _________________________________ SiteID: 015-021-002229 + Manager BusPhone: (661) 322-8860 Location: 1801 26TH ST Map 102 CommHaz Minimal City BAKERSFIELD Grid: 25B FacUnits: 1 AOV: CommCode: BFD STA Ol SIC Code:8021 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title M A GHALAMBOR DDS / / Business Phone: (661) 322-8860x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone (661) 335-6438x Pager Phone ( ) - x Hazmat Hazards: React Contact Phone: (661) 322-8860x MailAddr: 1801 26TH ST State: CA City :~ BAKERSFIELD Zip 93301 Owner M A GHALAMBOR DDS Phone: (661) 322-8860x Address 1801 26TH ST State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: , Emergency Directives: PROG H - HAZ WASTE GEN ~N~'D ~~~ ~ D 2®os ~~ i ~~ ~` Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. Signature Date -1- 05/19/2006 - _ '~ _ __ _ ___ _ _ _ _ __ 3 ~~ ~ nom. - ~~ ~ :.-. ~ - ~ ~ ~ ~ ~ ,~__= -~' ~ Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST B A r R s r ,~_; 0 9l)oTruxtunAve., suite 210 - e~~ __ ~~,~~~x~_~~~..~::.~ _,. _-_~ -.~._ ,.~s.b_ ~ , FARE Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program "R"" Tel.: (Ball 326-3979 - Fax: (661) 872-2171 FACILITY NAME - INSPE TION DATE INSPECTION TIME ADDRESS ~ ~ dot 'L~ PHONE NO. 3~-8$6~ O OFEMPLOYEES Io FACILITY CONTACT ~ - BUSINESS ID NUMBER 15-021-OIS -~ ~ "U ~ ' Section 1: Business Plan and Inventory Program r ^ ROUTINE ~ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation - COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS - ^ CORRECT OCCUPANCY ~ ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ~~ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^~ FIRE PROTECTION r J, ~ ~ '~~ ~/Q ~~l f1r ~, 1.1 ~'+`~ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? 1.[~YES ^ NO EXPLAIN: t,}~as'~-_c~ ~~~ ~ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (667) 326.3979 C ~~ ~ ~~. Inspector (Please Print) Fire Prevention / 1~` In /Shift of Site/Station # _ f ` i ,Z-Z'~ .ZZ~4 White -Prevention Services Yellow -Station Copy Pink -Business Copy ~ FD 2155 (Rev. 09/05 .z ~'~~` T~`~ CITY OF BAKERSFIELD FIRE DEPARTMENT `~ ~~ OFFICE OF ENVIRONMENTAL SERVICES ~° ~~' UNIFIED PROGRAM INSPECTION CHECKLIST .~ ~p~ 1715 Chester Ave., 3~d Floor, Bakersfield, CA 93301 4 FACILITY NAME rv ~ ~ 2 mob <, ~ e ^~'~ ~ s ~ ~ INSPECTION DATE "I" ~ Zb ~ s Section 4: Hazardous Waste Generator Program EPA ID # ~ IG ~ ~~ 17t ^ Routine `[3 Combined ^ Joint Agency ^Muiti-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number ~~ ~ ~- ~` Authorized for waste treatment and/or storage Reported release, fire, or explosion within 15 days of occurcence 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 ~ wic ~ S ~ ~ Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels ~1//~ Proper management of used oil filters Transports hazardous waste with completed manifest ~~~~-~ ~ ~S~ r ~ Sends manifest copies to DTSC 4, ,~ ~ Retains manifests for 3 years Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years /~ Determines if waste is restricted from land disposal ~,=~,omp--ance v=v~oianon , Inspector~~ ~'~~ ^'-~ • l -' .•2 Office of Environmental Services (661) 326-3979 Business Site Respons~ ~ P y White -Env. Svcs. Pink -Business Copy ~/~ ::a: s NEW IMAGE DENTISTRY Manager ~~ ~?~~-~.. _ I~~, ~~t~~ H~ ~,>a Location: 1801 26TH ST City BAKERSFIELD CommCode: BFD STA O1 EPA Numb: a~~3~ BusPhone: Map 102 Grid: 25B SitelD: 015-021-002229 (661) 322-8860 CommHaz Minimal FacUnits: 1 AOV: SIC Code:8021 DunnBrad: Emergency Contact /' Title Emergency Contact / Title M A GHALAMBOR DDS / O`W >ti_~ !t ~ / Business Phone: (661) 322-8860x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone (661) 335-6438x Pager Phone ( ) - x Hazmat Hazards: React Contact ~1'~R-- G' ~+~LR•;n~~0~:,,` Phone: (661) 322-8860x MailAddr: 1801 26TH ST State: CA City BAKERSFIELD Zip 93301 Owner M A GHALAMBOR DDS Phone: (661) 322-8860x Address 1801 26TH ST State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ PROG H - HAZ WASTE GEN `~~ ~ \ ENT'0 APR 2 2007 6 Lased on my inquiry of those individuals responsible far obtaining the informati on, I c,~rti`y under penalty of law that f have personall i y exam ned and am familiar with the information submitted and believe th e information is true, accur ,and comp) ,te. ~ ign t a ure Date -1- 02/05/2007 F NEW IMAGE DENTISTRY SiteID: 015-021-002229 ~ ~ 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 2.00 GAL Min -2- 02/05/2007 -3-. 02/05/2007 F NEW IMAGE DENTISTRY SiteID: 015-021-002229 ~ ~ 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: UTILITY RM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TWaste ~ Ambient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average S • CJ ~ ~'O~~AL S ~-8•@--•~~ S . ~j Q , ~...~A-0--- GAL - r1ti~r~x.Lw~ ~vl~irvlvl;lv~t~5 %Wt. RS CAS# Silver No 7440224 t11~GHKL A551'S551~1L'1V1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 02/05/2007 ,: F NEW IMAGE DENTISTRY SiteID: 015-021-002229 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ tiyeucy ivozi=icazion ~G1~ ~ << . ,_ P~Ill~J1 Vy CC 1VV 111 ~ P~VCi I: UCl 1. 1.V11 ~ ~-lp~'~ ~~``v1 G ~~a eJ~L S _,_ , ,~ i"UiJl1V ivV l~11 . ~ P~VCL I.UQ I.l Vll ~ ©~ ~~ ~ ~ a-~ ~ ~ ~ ~~~b ~ ~ ~ -5- 02/05/2007 F NEW IMAGE DENTISTRY SiteID: 015-021-002229 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ .'Release-Prevention ,' Release Containment wean up ; Lgtis~r ~~~ I l~ ~",,~f L ~V,So~ V~.11CL 1CC.7VU1 l:C HUl.1 VCLL1Vll -6- 02/05/2007 F NEW IMAGE DENTISTRY SitelD: 015-021-002229 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .7~1CC:1d1 !1dGdIU~ Utility Shut-Offs ~~~~ ~ Fire Protec./Avail. Water,' ~~ S~ ~~ kl n c ~, 9~~_~ J J ~~ ~ ~ 1~ 7 d, r «~~ Building Occupancy Level rC~ p `^ ~~ /~ ~ ~!'h ~r ~u 1~~~ ~~ a ~, -7- 02/05/2007 F NEW IMAGE DENTISTRY SiteID: 015-021-002229 ~ Fast Format ~ ,,Training Overall Site ~ ~_,Employee Training-. ....- - -- rays ~ Held for Future Use nciu ivt ru~.utc vac -8- 02/05/2007