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Home My WebLink AboutBUSINESS PLAN 5/26/2006~ ` '~' SHIRLEY MAN, DDS ~ ~ ~'i~ 3600 DE SOUZA PLACE #A ~r -- - - - - :~ - -- f -, ~1,. + MAN DDS SHIRLEY _____________________________________ SiteID: 015-021-002343 + 5t+ i ~.zc-~~ ,n~AN Manager I+~u: ' ^ T L'T ~'~' Location: 3600 DE SOUZA PL A City BAKERSFIELD BusPhone: (661) 834-3600 Map 123 CommHaz Minimal Grid: 11B FacUnits: 1 AOV: CommCode: BFD STA 07 EPA Numb: SIC Code:8021 DunnBrad: Emergency Contact / Title Emergency Contact / Title WARREN Lt lA / OWNER i~T'~V q~~r.'~v 5~,,~y M,~ OFFICE MANAGER Business Phone: (661) 834-3600x Business Phone: (661)-~°'' °'" ~ ~3~.~t~ 24-Hour Phone (661) 834-3600x 24-Hour Phone (661) 834-3600x Pager Phone ( ), - x Pager Phone ( ) - x Hazmat Hazards: React Contact Phone: (661) 834-3600x MailAddr: 3600 DE SOUZA PL A State: CA City BAKERSFIELD Zip 93309 Owner SHIRLEY MAN DDS Phone: (661) 834-3600x Address 3600 DE SOUZA PL A State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: , ~ Emergency Directives: PROG~H - HAZ WASTE GEN ENT ~~N ~ s 2 406 Based on mY inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that ! have examined and am familiar with the Inforrnaeon submitted and believe the information is true, accurate, and complete. Signature ~ Z~ '-~ 6 Date -1- 05/18/2006 ti'a.'' I MAN DDS SHIRLEY Manager SHIRLEY MAN DDS Location: 3600 DE SOUZA PL A City BAKERSFIELD SiteID: 015-021-002343 BusPhone: (661) 834-3600 Map 123 CommHaz Minimal Grid: 11B FacUnits: 1 AOV: CommCode: BFD STA 07 EPA Numb: SIC Code:8021 DunnBrad: Emergency Contact / Title Emergency Contact / Title WARREN LIU / OWNER SHIRLEY MAN / OFFICE MANAGER Business Phone: (661} 834-3600x Business Phone: (661) 834-3600x 24-Hour Phone (661) 834-3600x 24-Hour Phone (661) 834-3600x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact Phone: (661) 834-3600x MailAddr: 3600 DE SOUZA PL A State: CA City BAKERSFIELD Zip 93309 Owner SHIRLEY MAN DDS Phone: (661) 834-3600x Address 3600 DE SOUZA PL A State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif ' d: RSs : No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ENS ~~~ ~ ~ ~~ ~ A. Based on my inquiry of these individuals ible for chaining the information, 0 certify respons under penalty of law that I have personally ined and am familiar with the information exam submitted and believe the information i~ true, accurate, and complete. p ~ ' ,~,~ ,~I, E/ .~ ~~ V Signature Date. -1- 02/02/2007 i`(i F MAN DDS SHIRLEY ~ Hazmat Inventory = ~ MCP+DailyMax Order = SiteID: 015-021-002343 ~ By Facility Unit ~ Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE FIXER R L 5.00 GAL Minl -2- 02/02/2007 ;~ -3- 02/02/2007 ,,. F MAN DDS SHIRLEY ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME WASTE FIXER Location within this Facility Unit STATE TYPE PRESSURE Liquid TWaste ~ Ambient SiteID: 015-021-002343 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# TEMPERATURE CONTAINER TYPE Ambient -~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL r1t~~t~tcLUU~ uul~iruivl~;iv-1~ °sWt . RS CAS# Silver No 7440224 t1AGH1{L A55t5551~1iS1V'1'S TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 02/02/2007 F MAN DDS SHIRLEY SiteID: 015-021-002343 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 04/04/2002 ~ CALL 911 FOR RESPONSE TEAM Employee Notif./Evacuation 04/04/2002 CALL 911 FOR RESPONSE TEAM - r I,LU l l ~. 1V V 1.1 1 ~ Li V Cl l: UQ l.1 V l l Emergency Medical Plan CALL 911 FOR HELP AND LOCAL HOSPITAL 04/04/2002 -5- 02/02/2007 F MAN DDS SHIRLEY SiteID: 015-021-002343 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 04/04/2002 ~ HAZARD TRAINING IN WASTE PROCEDURES Release Containment 04/04/2002 SECONDARY WASTE TANK CONTAINMENT Clean Up 05/18/2006 WASTE HAULER REMOVES WASTE BI-MONTHLY, X-RAY SOLUTION SERVICE CO. CLEAN UP WITH TOWELS AND WATER. Other Resource Activation -6- 02/02/2007 F MAN DDS SHIRLEY SiteID: 015-021-002343 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~J~JCC:ld1 LldGdtli.7' = UL111Ly SnuL-ULLS- Cr ~~- ~ rJl~-°~ ~a ~. S 1 ~1x= v f= i3 u i ~ b ~ ~- ~- - t.~:= f~ti~t, ~~ -~~ j~ ~ r-~.7~2 c. i'ty •- 1•.~ 0~-71-F $ r ~ c~(= P~ vt ~- U! ~/ Cr ~ C.,Ly.--Z~ L ~ ov W ~T~~ - SOc.y'T1~ 5i~[ oi= ~ivf 1,~fNG- ~L~7 tv 51DC- WALK C~"l1T~~-~-1iur- ~„ , 1'116 C1Vl..CV / 17Vall. YY0. l..C1 2 - ~ ~VL T 1~~ t ~- ~~~AVa-per fycT tN G~ t S f~Ft`ti2 S Building Occupancy Level 05/18/2006 4 EMPLOYEES -7- 02/02/2007 ~' 'Y F MAN DDS SHIRLEY SiteID: 015-021-002343 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 02/02/2007 ~ MSDS SHEETS ON FILE IN OFFICE BRIEF SUMMARY OF TRAINING PROGRAM: YEARLY OSHA HAZARDOUS MATERIALS TRAINING rayc ~ ncs.u tvt ru~uic ~5c nciu ivL ru~uic mac -8- 02/02/2007 MAN DDS SHIRLEY SiteID: 015-021-002343 Manager VENUS TRIGUERRO Location: 3600 DE SOUZA PL A City BAKERSFIELD BusPhone: (661) 834-3600 Map 123 CommHaz Minimal Grid: 11B FacUnits: 1 AOV: CommCode: BFD STA 07 EPA Numb: SIC Code:8021 DtznnBrad Emergency Contact / Title Emergency Contact / Title WARREN LIU / OWNER VENUS TRIGUERRO / OFFICE MANAGER Business Phone: (661) 834-3600x Business Phone: (661) 834-3600x 24-Hour Phone-: (661) 834-3600x 24-Hour Phone (661) 834-3600x Pager Phone- ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact SHIRLEY MAN Phone: (661) 834-3600x MailAddr: 3600 DE SOUZA PL A State: CA City BAKERSFIELD Zip 93309 Owner SHIRLEY ,MAN DDS Phone: (661) 834-3600x Address 3600 DE SOUZA PL A State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif~d: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN E3ased on my inquiry of those individuals respon:>iole for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted andoelieve the information is true, accurate, and o m c plete. c~-/~/ I 7 ~ l l ~ ignature Date -1- 07/12/2007 7 ~ F MAN DDS SHIRLEY SiteID: 015-021-002343 9 ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE FIXER R L 5.00 GAL Min -2- 07/12/2007 -3- 07/12/2007 ~~ F MAN DDS SHIRLEY ~ Inventory Item 0001 !Y/1T /1~Rl~TT 1TT TfT ~ iYTTTftT iY-nr ~tw ~~r Liquid I Waste Largest Container 5.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum I Daily Average 5.00 GAL 5.00 GAL nr~c,riRDOUS COMPONENTS %Wt• RS CAS# Silver No 7440224 Y1HGriCCL ti.7 J~J.71~1P~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min SiteID: 015-021-002343 ~ Facility Unit: Fixed Containers at Site ~ TEMPERATURE CONTAINER TYPE Ambient ~STIC CONTAINER Ambientvy~y -4- 07/12/2007 F MAN DDS SHIRLEY SiteID: 015-021-002343 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 04/04/2002 ~ CALL 911 FOR RESPONSE TEAM Employee Notif./Evacuation 04/04/2002 CALL 911 FOR RESPONSE TEAM Public Notif./Evacuation 02/27/2007 CALL 911 FOR RESPONSE TEAM. Emergency Medical Plan 04/04/2002 CALL 911 FOR HELP AND LOCAL HOSPITAL -5- 07/12/2007 F MAN DDS SHIRLEY SiteID: 015-021-002343 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 04/04/2002 ~ HAZARD TRAINING IN WASTE PROCEDURES Release Containment 04/04/2002 SECONDARY WASTE TANK CONTAINMENT Clean Up 05/18/2006 WASTE HAULER REMOVES WASTE BI-MONTHLY, X-RAY SOLUTION SERVICE CO. CLEAN UP WITH TOWELS AND WATER. V1.11C1 1CC.7-V UlUC L"11.: 1.1Vd1~1 V11 -6- 07/12/2007 r F MAN DDS SHIRLEY SiteID: 015-021-002343 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ 1JjJeC;1d1 ric3GdiC1S Utility Shut-Offs 03/20/2007 GAS - N SIDE OF BLDG ELECTRIC - N SIDE OF BLDG WATER - W SIDE OF BLDG Fire Protec./Avail. Water TWO PORTABLE RETARDANT EXTINGUISHERS AND DOMESTIC TAP WATER. FIRE HYDRANT: 100FT SW OF BLDG 03/20/2007 Building Occupancy Level 05/18/2006 4 EMPLOYEES -7- 07/12/2007 ;. , ; :. F MAN DDS SHIRLEY SiteID: 015-021-002343 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 02/02/2007 ~ MSDS SHEETS ON FILE IN OFFICE BRIEF SUMMARY OF TRAINING PROGRAM: YEARLY OSHA HAZARDOUS MATERIALS TRAINING rayc c nciu ivi ru~.utc ~~c nciu ivi ru~u.LC v5C -8- 07/12/2007 r~ ,. + GAVIN DDS RICK T ____________________________________ SiteID: 015-021-002342 + Manager Location: 3600 DE SOUZA PL City BAKERSFIELD BusPhone: (661) 831-4533 Map 123 CommHaz Minimal Grid: 11B FacUnits: 1 AOV: CommCode: BFD STA 07 EPA Numb: SIC Code:8021 DunnBrad: Emergency Contact / Title Emergency Contact / Title RICK T GAVIN DDS / ~B S / Business Phone: (661) 831-4533x B1~i-ness~i~~re•:-(6-63-} 831-9595x 24-Hour Phone (b61) ~~ -o3~Ox 2-~ -He~3, ~~-=ne ( ) - x Pager Phone ( ) - x r~~r p1,nnP : ( ) - X Hazmat Hazards: ~ React ~'~ ------------ Contact Q c_Y.~S-~-~~`'~~ ~ Phone: (661) 831-4533x MailAddr: 3600 DE SOUZA PL State: CA City BAKERSFIELD Zip 93309 Owner RICK T GAVIN DDS Phone: (661) 831-4533x Address 3600 DE SOUZA PL State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ 11~ PROG H - HAZ WASTE GEN I `~ Based on m r$sPonsible fort ~nRuirY of tho under obtainin examined na1tY of layVghae inforrreatio a~j ideals submitted ana am familiar certif accu believe the wl th the infor ona11Y te, and c mp-ete. information is atuen Signature D ~ -23 - pCo ate ENT J U L ~ 12806 ~~~` 5`~ -1- 05/17/2006 ~- GAVIN DDS RICK T Manager RICK T GAVIN Location: 3600 DE SOUZA PL City BAKERSFIELD SiteID: 015-021-002342 BusPhone: (661) 831-4533 Map 123 CommHaz Minimal Grid: 11B FacUnits: 1 AOV: CommCode: BFD STA 07 EPA Numb: SIC Code:8021 DunnBrad: Emergency Contact / Title Emergency Contact / Title RICK T GAVIN DDS / OWNER / Business Phone: (661) 831-4533x Business Phone: ( ) - x 24-Hour Phone (661) 979-0370x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact RICK T GAVIN Phone: (661) 831-4533x MailAddr: 3600 DE SOUZA PL State: CA City BAKERSFIELD Zip 93309 Owner RICK T GAVIN DDS Phone: (661) 831-4533x Address 3600 DE SOUZA PL State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ~N~Q~ ~~ ~ ~ ~QO~ ased an my inquiry of these individuals r;:;~~t;r~sib!e i:~r ohta.ining the information, I certify unc+er penaify of lave that I have personally examined and am familiar with the information submitt~. and bFlieve the information is true, accur a and' m lete. ~~ _ - ~ ~U~ Signature Date -1- 07/11/2007 F GAVIN DDS RICK T SiteID: 015-021-002342 ~ ~~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- 07/11/2007 -3- 07/11/2007 F GAVIN DDS RICK T SiteID: 015-021-002342 ~ 'Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: DARKROOM CAS# STATE TYPE PRESSURE TEMPERATURE ~ CONTAINER TYPE Liquid TWaste ~mbient Ambient I PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 2.00 GAL 2.00 GAL 2.00 GAL tir~~rjtcLUUS uurirui~~iv~l~5 sWt. RS CAS# Silver No 7440224 t1AGHKL 1-~. 7aL' JJ1~1L'1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 07/11/2007 F GAVIN DDS RICK T SiteID: 015-021-002342 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 07/21/2006 ~ BRENDA NOTIFIES DR GAVIN WHO CALLS JERRY WARREN, WASTE DISPOSAL SERVICE. Employee Notif./Evacuation 07/21/2006 BRENDA NOTIFIES DR GAVIN WHO CALLS JERRY WARREN, WASTE DISPOSAL SERVICE. Public Notif./Evacuation DR GAVIN PHONES 911. 02/27/2007 Emergency Medical Plan 05/17/2006 MERCY SOUTHWEST. WE HAVE VENTLATION OF AREA. ALSO, EYE WASH STATION. -5- 07/11/2007 F GAVIN DDS RICK T SiteID: 015-021-002342 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/17/2006 ~ THERE IS AN OVERFLOW VESSEL THAT RESIDES IN A CONTAINMENT POT. Release Containment 02/27/2007 OVERFLOW VESSEL RESIDES IN A CONTAINMENT POT. Clean Up 05/17/2006 CALL WASTE HAULER AND REMEDY SITUATION. v~..iic1 iccavutt,c til:l.lVCLl.1V11 -6- 07/11/2007 F GAVIN DDS RICK T SiteID: 015-021-002342 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ -~ -~- Vt.J G~..1Q1 110.4Q11A ~7 Utility Shut-Offs 03/20/2007 GAS - N SIDE OF BLDG ELECTRIC - N SIDE OF BLDG WATER - E SIDE OF BLDG Fire Protec./Avail. Water 03/20/2007 FIRE EXTINGUISHERS AND HOSE BIBS CITY WATER. FIRE HYDRANT - 100FT SW OF BLDG. Building Occupancy Level 05/17/2006 5 EMPLOYEES -7- 07/11/2007 .-- F Ci~,VIN DDS RICK T SiteID: 015-021-002342 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/17/2006 ~ MSDS SHEETS ON FILE BRIEF SUMMARY OF TRAINING PROGRAM: ANNUAL REVIEW PROVIDED BY KCDS, FOLLOWED BY IN-OFFICE TRAINING. rays n.c ltl 1V1 rul. U1C u~C nc.LU .LUi r u~u.LC U5C -8- 07/11/2007 . r~l~D~ UNI~E17 PROGRAM INSPECTION CHECKLIST' ~- ~-:~~. m~...__._,_ _-_~ ._._~.~.__~_-___-_ __ SECTION 1: Business Plan and Inventory Program Prevention Services >3_ E R S F , __D 900 Truxtun Ave., Suite 210 F/RE Bakersfield, CA 93301 ~RrM r Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME INSPECTIj'N DATE INSPECTION TIME S~,\ 6ZtrE ~ t~A N ~ ~ S /2 0 ADDRESS 3 C~~ O ~ e Sou L~ ~ ~,.. PHONE NO. 3 -,~' NO OF EMPLOYEES FACILITY CONTACT BUSINESS ID NUMBER 15-021- ~ 3 Section 1: Business Ptah and Inventory Program ^ 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 t ^ VERIFICATION OF LOCATION _ ~ ~ /~ _ ~/ ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY - ^ VERIFICATION OF HAZ MAT TRAINING 'J'~ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ ` CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ ~ FIRE PROTECTION SaCryiL2 ~` r Q ~`y ~ \i ~` ` ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON S E? YES ^ NO EXPLAIN: ~-A ~^~C ~~ ~CO - QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1s` In /Shift of Site/Station # ~N!(,~u=Y ~~ White -Prevention Services Yellow -Station Copy Pink - Business Copy FD 2155 (Rev. 09/05 .r ~. t04~` T~`" CITY OF BAKERSFIELD FIRE DEPARTMENT ~ ~~ OFFICE OF ENVIRONMENTAL SERVICES `° , ~ ~~ UNIFIED PROGRAM INSPECTION CIIECKLIST ~~`~/ 1715 Chester Ave., 3'd Floor, Bakersfield, CA 93301 FACILITY NAME S l~ 1 RLE y M Pt ryJ,D S INSPECTION DATE 3 Zo ~~ Section 4: Ilazardous Waste Generator Program EPA ID # ~£ r"p~ ^ Routine -~ Combined ^ Joint Agency ^Multf-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number ~~(~ y~,~ ~ 'C'- Authorized for waste treatment and/or storage ~d , .f. Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers aze kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line N Secondary containment provided Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste - N Proper management of lead acid batteries including labels N Proper management of used oil filters N Transports hazazdous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years -~' .. -. Retains hazardous waste analysis for 3 years ~ _ R a. S~ ~. Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal L=~ompuanc/e v=vtotatton Inspector: G ~~'~'' Office of Environmental Services (661) 326-3979 White -Env. Svcs. Busine t e esponsible Party Pink -Business Copy _ - ~o~'~ ~~ ~ i UNIFI~D PROGRAM INSPECTION CHECKLIST ik B__ a R__s F , _..~ ....._D SECTION 1: Business Plan and Inventory Program ~~ r Prevention Services 900 Truxtun Ave. , Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-21.71 FACILITY NAME INSP TION D TE ~ ~ INSPECTION TIME tic Grp ~,~ D S 0 20 ADDRESS 3 ~ o c~ D ~ Sou 2 ~ -6~ t PHONE NO. ~''~ i ~ y-S33 NO OF EMPLOYEES s' FACILITY CONTACT ~.~. ~ ~ ~^~ 5` y~-. ~ ,~. +L BUSINESS ID NUMBER , G~)__. 15-021- ~- ~ `~ O Sec#ion 1': Business Plan and Inventory Program ^ 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 4 ~ ^ 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? ~j'ES ^ NO EXPLAIN: ~ C S~Q Tj~~ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 e~~, ~, ~ , Inspector (Please Print) Fire Prevention / 1s` In /Shift of Site/Station # Bus Hess Site / sponsib a Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 ~-'~ ,04y. T~,~'e ~ec ~~1 ,~~~~~ FACILITY NAME ~ 1 c I~ ~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 1-~U 1 ev ,D ~ S__ INSPECTION DATE ~ I ~ ~ G ~ Section 4: Hazardous Waste Generator Program EPA ID # ~ ~'`'` P fi ^ Routine ~ Combined ^ Joint Agency ^Muiti-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number ~x ~ M {~'1" Authorized for waste treatment and/or storage t ~',~ 7¢ "- Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least SO feet from property line ~~ Secondary containment provided Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste ~ Proper management of lead acid batteries including labels ~/ ~ Proper management of used oil filters N l~ Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years ~i n.. ~R4/~~l~ Retains hazardous waste analysis for 3 years ~- !Za Salty ~~, Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal C=Compliance V=Violation Inspector: ~ - ~ ~ ~ ~ ~" t ~ P Office of Environmental Services (661) 326-3979 White -Env. Svcs. ' / ~~'~`'t~ Busi ess Site Responsible Party Pink -Business Cop ,.- ~, .~ - GAVIN DDS RICK T Manager ~~~ ~~-~i,~ Location: 3600 DE SOUZA PL City BAKERSFIELD CommCode: BFD STA 07 EPA Numb: SitelD: 015-021-002342 BusPhone: (661) 831-4533 Map 123 CommHaz Minimal Grid: 11B FaCUnits: 1 AOV: SIC Code:8021 DunnBrad: Emergency Contact / Title Emergency Contact / Title RICK T GAVIN DDS / ~ W~.Q/"' / Business Phone: (661) 831-4533x Business Phone: ( ) - x 24-Hour Phone (661) 979-0370x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact RICK T GAVIN DDS Phone: (661) 831-4533x MailAddr: 3600 DE SOUZA PL State: CA City BAKERSFIELD Zip 93309 Owner RICK T GAVIN DDS Phone: (661) 831-4533x Address 3600 DE SOUZA PL State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ENT'D ~ E E ~ 6 2007 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 submittP and believe the information is true, accur- a and complete. ~ / -_l Z~~ S nature Date -1- 01/31/2007 r ~. F GAVIN DDS RICK T ~ Hazmat Inventory = ~ MCP+DailyMax Order = SiteID: 015-021-002342 ~ By Facility Unit ~ Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE FIXER R L 2.00 GAL Min r -2- 01/31/2007 -3- 01/31/2007 A L F GAVIN DDS RICK T ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME WASTE FIXER Location within this Facility Unit DARKROOM SiteID: 015-021-002342 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# STATE TYPE PRESSURE Liquid TWasteAmbient TEMPERATURE CONTAINER TYPE Ambient -~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 2.00 GAL 2.00 GAL 2.00 GAL rit~~t~tcl~w5. ~~inr~lv~;lv'1~ °sWt. RS CAS# Silver No 7440224 riAGH.ttL A55t5551~1L1V'1'J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 01/31/2007 ,~ -~ F GAVIN DDS RICK T SiteID: 015-021-002342 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 07/21/2006 ~ BRENDA NOTIFIES DR GAVIN WHO CALLS JERRY WARREN, WASTE DISPOSAL SERVICE. Employee Notif.jEvacuation 07/21/2006 BRENDA NOTIFIES DR GAVIN WHO CALLS JERRY WARREN, WASTE DISPOSAL SERVICE. _ , ~ ~, Emergency Medical Plan 05/17/2006 MERCY SOUTHWEST. WE HAVE VENTLATION OF AREA. ALSO, EYE WASH STATION. -5- 01/31/2007 ~. F GAVIN DDS RICK T SiteID: 015-021-002342 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/17/2006 ~ THERE IS AN OVERFLOW VESSEL THAT RESIDES IN A CONTAINMENT POT. iCC1CQ.7C 1. V111. Gi 111l11C11V Clean Up 05/17/2006 CALL WASTE HAULER AND REMEDY SITUATION. vt.licl. l~c~vui.~.c n~.l.ival.ivll -6- 01/31/2007 F GAVIN DDS RICK T SiteID: 015-021-002342 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ -7~1CC~1ci1 na~atu5 Utility Shut-Offs ,~ , 1' 116 r.iv~.c~.. ~ tavaii rva~.ci Building Occupancy Level 05/17/2006 5 EMPLOYEES -7- 01/31/2007 ~, ,_ _' F GAVIN DDS RICK T SiteID: 015-021-002342 ~ Fast Format ~ ~ Training Overall Site ~ Employee Training 05/17/2006 I MSDS SHEETS ON FILE BRIEF SUMMARY OF TRAINING PROGRAM: ANNUAL REVIEW PROVIDED BY KCDS, FOLLOWED BY IN-OFFICE TRAINING. rayC ~ nCiu iui ru~.ui~ u5C nclu ivi ru~uLe use -8- 01/31/2007