Loading...
HomeMy WebLinkAboutBUSINESS PLAN 7/14/2007MT. VERNON DENTISTRY 2302 COLUMBUS STREET - - -_ _. ~ I~_ >, r!. J, , r F: - _ MT VERNON DENTISTRY Manager F MEHDIPOUR Location: 2302 COLUMBUS ST City BAKERSFIELD CommCode: BFD STA 08 EPA Numb: BusPhone: Map 103 Grid: 22A SIC Code: DunnBrad: SiteID: 015-021-002883 (661) 873-1111 CommHaz Minimal FacUnits: 1 AOV: Emergency Contact / Title Emergency Contact / Title DR PRAM / CEO/OWNER. F MEHDIPOUR / CFO Business Phone: (661) 873-llllx Business Phone: (661) 873-llllx 24-Hour Phone (661) 873-llllx 24-Hour Phone (661) 873-llilx Pager Phone (714) 299-0826x Pager Phone' (310) 383-2084x Hazmat Hazards: React Contact F MEHDIPOUR Phone: (661) 873-llllx MailAddr: 2302 COLUMBUS ST State: CA City BAKERSFIELD Zip 93306 Owner F MEHDIPOUR DMD & DR PHAM Phone: (661) 873-llllx Address 2302 COLUMBUS ST State: CA City BAKERSFIELD Zip 93306 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ~, ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ENT'D ~1 U ~. 1 ~ ~Qp~ Based on my inquiry of those individuals respcnsihle for obtaining the information, 1 certify under penalty of lav~r that I have personally ©xamined and am familiar troith the information submitted and believe the information is true, accurate, and complete. e ~/~` - Sig a re~ Date -1- 07/12/2007 F MT VERNON DENTISTRY SiteID: 015-021-002883 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... ISpecHaz`EPA Hazards) Frm I DailyMax IUnitIMCPI WASTE FIXER R L 6.00 GAL Minl -2- 07/12/2007 ^++~ .; -3- 07/12/2007 _ ~f y F MT VERNON DENTISTRY SiteID: 015-021-002883 ~ ~ 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: STORAGE RM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Waste ~ Ambient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 6.00 GAL 6.00 GAL 6.00. GAL HAZARDOUS COMPONENTS %Wt. RS CAS# Silver No 7440224 11HGKKL L3w 7.71'.w7.'~1°1L' 1V 1 ~J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 07/12/2007 r. Lj ~ F MT VERNON DENTISTRY SiteID: 015-021-002883 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification Employee Notif./Evacuation ,~ tUJ.J11V 1VV 1..11. ~ P~VCL I.Udl.1 V11 P~LlIClyClitry 1.1C Ull.:dl t'ldll -5- 07/12/2007 F MT VERNON DENTISTRY SiteID: 015-021-002883 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ _, ncica~c ricvcii~.ivit _~ ncica.7c L. V111. G1111lllCll 1. l.. l G Qll l.lt.J V 1.11CL rcCSC~ui c:~ sic l.lvcll.loil -6- 07/12/2007 _ ~:,__1: F MT VERNON DENTISTRY SiteID: 015-021-002883 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ _, .~Z/c~.ial. nac.atu~ Utility Shut-Offs .. . i-iic riv~.c~..~t~vaii rvcil..Ci Building Occupancy Level -7- 07/12/2007 J'i.. .~ -~. F MT VERNON DENTISTRY SiteID: 015-021-002883 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training rays ~ i1c1U 1VL rLLI. ULC VAC ncLU 1VL t ULULC VIE'' -8- 07/12/2007 UN1~4'ED PROGRAM INSPECTION CHECKLIST? .SECTION 1: Business Plan and Inventory Program HASERSFIELD FIRE DEPT Prevention Services a p r/R~ 900 Truxtun Ave., Suite 210 AKIN Bakersfield. CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME NSP CTION DATE INSPECTION TIME ~-~ ~EQ.A~oti ~ ~ ~IS7Q~ I b 0 ~`ts --~ ADDRESS 2 3 o Z Gil u, .~.,~ ~s s~ HONE NO. $?3~ t `rJ O OF EMP OYEES FACILITY CONTACT USINESS ID NUMBER ~~~~ 15-021- Section 1: Business Plan and Inventory Program ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ~^ COMPLAINT ^ RE-INSPECTION C V (c=compliance OPERATION V=Violation - -- --- ------- COMMENTS ----- _--- ------------- -------------------------------- --- gy~pp,, ^ APPROPRIATE PERMIT ON HAND ~ J ,, 11~~ xtv . ^ BUSiflt?SS PLAN CONTACT INFORMATION ACCURATE /~1 ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ~]} ^ VERIFICATION OF INVENTORY MATERIALS D . VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION L~,R ^ PROPER SEGREGATION OF MATERIAL O VERIFICATION OF MSDS AVAILABILITY ~ > ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE ~ ON HAND ~ ~ ANY HAZARDOUS WASTE ON SITE? YES ^ NO EXPLAIN: ~JO ~ 1~~ ~I ~~ ~ - - ------- --------- QUESTION REGARDING THIS INSPECTION? PLEA8E CALL US AT (881) 528-3979 !O /// Inspector (Please Print) Fire Prevention / 1" In / hilt of Site/Station q us' it Site Responsible Pa ( se Print) White -Prevention Sorvices Yellow -Station Copy Pink -Business Copy FD2048 (Rw. 02105) ~* ~. ~0~~`" ~~~` CITY OF BAKERSFIELD FIRE DEPARTMENT ~~ ~ OFFICE OF ENVIRONMENTAL SERVICES ~° y UNIFIED PROGRAM INSPECTION CHECKLIST . ~cAgti 1'715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME I'~ ~ e s~~o ~v ~e ~S ~ s T~ ~l INSPECTION DATE `3 / ~ /O~ Section 4: Hazardous i~Vaste Generator Program ^ Routine ~ Combined ^ Joint Agency EPA ID # ^ Multi-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 occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames ~o Containers in good condition and not leaking .~ ENT'D MA ~ ~ ,~ ~~ ~° 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 ~'' ~~.1 Secondary containment provided Conducts daily inspection of tanks )lI r Used oil. not contaminated with other hazardous waste qJ Proper management of lead acid batteries including labels 03 f ~b Proper management of used oil filters ~ Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years ~,5,~ Retains hazardous waste analysis for 3 years ~GS'~ Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal ,~ =t/omptrance v=vrotatron Inspector: L~Gr~~.. Office of Environmental Services (661) 326-3979 White -Env. Svcs. Pink -Business Copy Business Site Responsible Party MT VERNON DENTISTRY Manager F MEHDIPOUR DMD Location: 2302 COLUMBUS ST City BAKERSFIELD SitelD: 015-021-002883 BusPhone: (661) 873-1111 Map 103 CommHaz Minimal Grid: 22A FacUnits: 1 AOV: CommCode: BFD STA 08 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title e w~~>L ~ Emerge y Contact / Title ~ ~~, P~~r., ~ ~~ ~ fir' Mai ©c.r ~ eF ~ Business Phone: (lGel) $'73- iII~ x Phone: ( ) - x Busines 2 4 -Hour Phone (ebb () g 7 3- i[ I l x 2 4 -Hour Phone ( ) - x Pager Phone ( )N% - x Pager Phone ( 3Jo ) 3 8 3- 2a~~x Hazmat Hazards: 7Jy ~ React -- -'t'a-ct-':--F-MERDIPOHR-~;•.~, --- - _ nh~ ~=-~~~=1-)---8-7:3=1-111 MailAddr: 2302 COLUMBUS ST State: CA City BAKERSFIELD Zip 93306 Owner F MEHDIPOUR DMD Phone: (661) 873-1111x Address 2302 COLUMBUS ST State: CA City BAKERSFIELD Zip 93306 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN =_-- --•- -Based on my inquiry of those individuals I certify i ~NI'D FEB ~ 1 X007 _ on, responsible for o6tatining the informat that I have personally - .. under penalty of law examined and am familiar with the information submitted and believe the information is true, accurate, and complete. t D e a Signature -1- 02/05/2007 ;, ... + MT VERNON DENTISTRY _________________________________ SiteID: 015-021-002883 + Manager F MEHDIPOUR DMD Location: 2302 COLUMBUS ST City BAKERSFIELD CommCode: BFD STA 08 EPA Numb: BusPhone: (661) 873-1111 Map 103 CommHaz Minimal Grid: 22A FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact / ~'itle Emergency Contact / Title / / Business Phone: ( ) - x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact F MEHDIPOUR DMD Phone: (661) 873-1111x MailAddr: 2302 COLUMBUS ST State: CA City BAKERSFIELD Zip 93306 Owner F MEHDIPOUR DMD Phone: (661) 873-llllx Address 2302 COLUMBUS ST State: CA City BAKERSFIELD Zip 93306 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif' d: RSs : No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ~N~ ~~~ 1 -~ X006 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. fj~ Signature ~ J ` ~ G Date ~~ ~~ -1- 06/07/2006 ~a~ UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmentai Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME /~/ ~ / IN°-S~PECTION DATE INSPECTION TIME Y1~T ~/ C.~"" Clt~ l / V" "t~ 7 J ~ 0~ -------------------- ----~-___ ---------- ------- ---- ------ -- ----- - C -- ---------_ __ _. ADDRESS PHONE No. No. of Employees Business ID Number FACILITYCONTACT F~Z~ MC-~1~>.Pac~t ~p ~ 15-021- ~'C~3 Section 1: Business Plan and Inventory Program ^ Routine ^ Combined ®Joint Agency OMulti-Agency ^ Complaint ^ Re-inspection C V nce l OPERATION t J on \ V=Vio a ^ ^ 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 AVAILABILITYE ^ ^ VERIFICATION OF HAT MAT TRAINING ^ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ ^ EMERGENCY PROCEDURES ADEQUATE ^ ^ CONTAINERS PROPERLY LABELED ^ ^ HOUSEKEEPING ^ ^ FIRE PROTECTION ^ ^ SITE DIAGRAM ADEQUATE ~ ON HAND COMMENTS PLUG 5~~~ .,a~rnitr~e.~,Y ANY HAZARDOUS~WA/Sy~T~E OWN SITES: Y~YES ^ NO EXPLAIN: ~" " ~~ (; ~ri`~~~ f.. QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT (66~) 326-3979 Inspector Badge No., Busine Site Responsible Party White • Environmental Services Yellow -Stefan Copy Pink • Business Copy T". C r~ -,.. .a ... - -... ~ ..4, ~ i •. 1 < 4. ~ t ~ Jt~1t. rU'ernon - - - _ - Dentistry _ ~ _~__~ "State 0,~ ,1.lfe Qxx `3,ami~~ and @aaneetic 1~?. eat~at~uy-- _N, Pham, D.M.D. 2302 Columbus St: (661) 873-111-1 - - Bakersfield, CA 93306 www.dentalwonders.com ~J!-lt. rlJ'ernon - -- Dentistry - -- "State 0.~ JAe (lnt ~.ami~ and @oenietic l~entietnc~-- F. Mehdipour, D.M.D. 2302 Columbus St. (661) 873-1111 Bakersfield, CA 93306 www.dentalwonders.com ;~ ,; , > Kt ~~ s~„ ~~ ,~ . r ~~~ ~.: .R ~- ..,,.„ ~~y N Nx ~ ~,A~~~ G~~ . ~~ j~,t ~, ~ Ii~ ~ ~'~ ~~ ~v~'~ t~~.v env ~s ~ k ~'~' ~ r~ ~' Y ~ 4 s f ~ i. ~ ~ ,~ :;.~ p v (f~ ;~~~ ~..: ?; ;' ~; ~, `~ "~ (~ L , -_~,, ~ ,~ v S . '~-, ~ ~ ~ ~ 4 ` ~ `'~'' R . f ~, ;. _ , r an i~`F t" .. ks i lvsxu :ti. eKx~w~~ ,3x.~ w~ {!Il.A". t ._ .,. -- - .. ~.E ?tdc~.7 ., •¢i4' ~ \u ,