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Home My WebLink AboutBUSINESS PLAN 5/15/2008!I '' EMPIItE SURGERY CENTER 4101 EMPIItE DRIVE #130 i~ i ~.,.t ... .-i EMPIRE SURGERY CENTER SiteID: 015-021-002919 Manager SUE WESTERFELD BusPhone: (661) 325-1900 Location: 4101 EMPIRE DR 130 Map 102 CommHaz High City I~AKERSFIELD Grid: 26D FacUnits: 1 AOV: CommCode: B~'D STA O1 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title SUE WESTERFELD - / ASC SUPERVISOR JAMES SHULERMD / MEDICAL DIR Business Phone: (661) 325-1900x Business Phone: (661) 325-3937x 24-Hour Phone (661) 399-3720x 24-Hour Phone (661) 665-2608x Pager Phone (661) 303-3099x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact SUE WESTERFELD Phone: (661) 325-1900x MailAddr: 4101 EMPIRE DR 130 State: CA City BAKERSFIELD Zip 93309 Owner EMPIRE SURGERY CENTER PARTNERS Phone: (661) 325-1900x Address 4101 EMPIRE DR 130 State: CA City BAKERSFIELD Zip 93309 Period to Preparers Certif'd: ParcelNo: TotalASTs: _ TotalUSTs: _ RSs: No Gall Gal Emergency Directives: PROG A - HAZMAT Based an my inquiry of those individuals ~ ~~o~ responuibie for obtaining the information, f certify under penalty of law that ! have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. Signature ~~ Date -1- 07/11/2007 F EMPIRE SURGERY CENTER SiteID: 015-021-002919 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE F P IH G 75.00 FT3 Hi OXYGEN F IH DH G 600.00 FT3 Low DIESEL, EMERG. GEN. FUEL L 55.00 GAL UnR -2- 07/11/2007 -3- 07/~1/2007 P EMPIRE SURGERY CENTER ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME NITROUS OXIDE Location within this Facility Unit STATE TYPE PRESSURE _ Gas TPure ~-Above Ambient AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 25.00 FT3 75.00 FT3 75.00 FT3 t1HG1-lt'CLVUJ 1:V1~1rV1V.C,1Vlb oWt. RS CAS# 100.00 Nitrous Oxide No 10024972 rlt~~r~tc1J r~JJl~JaJril;iviJ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi SiteID: 015-021-002919 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 10024-97-2 TEMPERATURE CONTAINER TYPE Ambient _PORT. PRESS. CYLINDER ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 7782-44-7 ~GaSATE TYPE T PRESSURE ~~ TEMPERATURE ~~ CONTAINER TYPE ~ TPure I Above Ambient I Ambient I PORT. PRESS. CYLINDER I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 150.00 FT3 600.00 FT3 600.00 FT3 til~iGtlttLVU.7. ~.VrlrvlvJJlv1.7 °sWt. RS CAS# 100.00 Oxygen, Compressed No 7782447 t11-~Gl-iCCL 1-~~ J~JJ;~7J1~1JJ1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -4- 07/11/2007 F EMPIRE SURGERY CENTER SiteID: 015-021-002919 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME ~~ DIESEL, EMERG. GEN. FUEL Days On Site 365 it Location within this Facility Unit Map: Grid: CAS# Liquid TMixture ~-Ambient~E ~ T~PeRATURE DRUM/BARRELEMETALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 55.00 GAL HAZARDOUS COMPONENTS ~ , %Wt. RS CAS# t1AY,KKL A7,~J;551~1t;1V'1'S TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UnR -5- 07/11/2007 F EMPIRE SURGERY CENTER SiteID: 015-021-002919 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification L'LIL~J1VyCC 1VV 1.11. ~ L' VdC.:Udl..1 V11 i^ t UJ.J1 ll: 1VV 1.11. ~ GVd~.-Udl.1 V11 L'LllC1y C11C~y 1.1C U1C:d1 Y1d11 -6- 07/11/2007 P EMPIRE SURGERY CENTER SiteID: 015-021-002919 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ KC1CcL~C YICVCi1l.1Ui1 KC1Cd5C l.Uill.dlillllCill. L.1Cd11 11~J Other Resource Activation -7- 07/11/2007 F EMPIRE SURGERY CENTER SiteID: 015-021-002919 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ -~ ,- Jj.lG 1.10.1 nac.alua Utility Shut-Offs 1'lIC rIVI.CL./LiVd11. Wdl.Cl a U1lullly vtr tr uYdtiuy LC V C1 -8- 07/11/2007 p i F EMPIRE SURGERY CENTER SitelD: 015-021-002919 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training rayC ~ riciu ivi r u~.uLC vac nC1u tVI t'UI.Ut~ U.5'~ -9- 07/11/2007 s . ;[t EMPIRE SURGERY CENTER SiteID: 015-021-002919 Manager SUE WESTERFELD BusPhone: (661) 325-1900 Location: 4101 EMPIRE DR 130 Map 102 CommHaz High City BAKERSFIELD Grid: 26D FacUnits: 1 AOV: CommCode: BFD STA Ol EPA Numb: ' SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact /' Title ~ir~ SUE WESTERFELD / ASC SUPERVISOR ~-S / A -MANA~G£~- Business Phone: (661) 325-1900x Business Phone: (661) .~c3a5- 24-Hour Phone (661) 399-3720x 24-Hour Phone (661) "'max 6~~a Pager Phone (661) 303-3099x Pager Phone (661) '~A~~~t Hazmat Hazards: Fire Press ImmHlth DelHlth Contact SUE WESTERFELD Phone: (661) 325-1900x MailAddr: 4101 EMPIRE DR 130 State: CA City BAKERSFIELD Zip 93309 Owner EMPIRE SURGERY CENTER PARTNERS Phone: (661) 325-1900x Address 4101 EMPIRE DR 130 State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif' d: RSs : No ParcelNo: Emergency Directives: PROG A - HAZMAT 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 famili i ~NTb FEB ar w th the information submitted and belie th 2 6 2007 ve e information is true , accurate, and complete. ~ `~ ~to O`7 Signature Date og~ -1- 01/30/2007 _~~ F EMPIRE SURGERY CENTER SiteID: 015-021-002919 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE F P IH G 75.00 FT3 Hi OXYGEN F IH DH G 600.00 FT3 Low DIESEL, EMERG. GEN. FUEL L 55.00 GAL UnR -2- 01/30/2007 -3- 01/30/2007 F EMPIRE SURGERY CENTER SiteID: 015-021-002919 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME NITROUS OXIDE Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 10024-97-2 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TPure ~-Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 25.00 FT3 75.00 FT3 75.00 FT3 ~- - tit',G1-1ttLVUS w1~1rv1viSlvlS %Wt. RS CAS# 100.00 Nitrous Oxide No 10024972 riHGL-1t~CL H5J~5Di~1~1V l 7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 7782-44-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TPure ~-Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATIONI Largest Coi50100rFT3 Daily 600100m FT3 I Daily 600r00e FT3 HAZARDOUS CGrirvly 1Jly 1 ~ %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 ri1-1GE~tCL H.7.71;vv1~1L"i1V l TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -4- 01/30/2007 j . a F EMPIRE SURGERY CENTER SiteID: 015-021-002919 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME DIESEL, EMERG. GEN. FUEL Days On Site 365 Location within this Facility Unit Map: Grid: CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Liquid TMixture ~ Ambient ~ Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 55.00 GAL 55.00 GAL 55.00 GAL oWt. RSA CAS# riHGFiKL A~a~551~1~1V~1~~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UnR HAZARDOUS COMPONENTS -5- 01/30/2007 F EMPIRE SURGERY CENTER SiteID: 015-021-002919 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification ,~ ~IIl~J1VyCC lVV l.11 j PTV Q1:Udl.1 V11 i_ t U3,J.L 1(.: 1VV 111 j P~Vdl: l.ld L1V11 LdllC 1. l~C11C:y 1.1C 111 C~d1 Y1d11 -6- 01/30/2007 ti. F EMPIRE SURGERY CENTER SiteID: 015-021-002919 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention ~i iCC1G0..7C l.lJlll..0.111111C11L r7 ~.1 GGill VL../ V 1. i1Cl iCG.7Vl11 VC L'11: 1..LV0.L1Vll -7- 01/30/2007 F EMPIRE SURGERY CENTER SiteID: 015-021-002919 ~ Fast Format ~ ~.-'Site Emergency Factors Overall Site ~ ~7iJCL 1d1 Ild'G dl lid Utility Shut-Offs ,_ riic riv~.c~..~rivai.i. vva~.ci D u111.L111y Vla: IL~JQ11C:y LC V C1 -8- 01/30/2007 :~ F EMPIRE SURGERY CENTER SiteID: 015-021-002919 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training rayc ~. Held for Future Use Held for Future Use -9- 01/30/2007 ,. ~ UNIFIED PROGRAM INSPECTION ~HECKLIST ~' .SECTION 1: Business Plan and Inventory Program C7 BAKERSFIELD FIRE DEPT a p Prevention Services ~~RS 900 Truxtun Ave., Suite 210 ~Rrr ~ Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME ~ NSPECT,IO~NJDAA'TE ~j~ INSPECTION TIME ADDRESS ~ ~ ~ HONE NO. O OFEMPLOYEES FACILITY CO~ CT ~ USINESS ID NUMBER 15-021- ~,Q- ~~ c Section 1: Business Plan and Inventory Program y~ ~ ~~ ROUTINE D COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (~=Compliances OPERATION COMMENTS V=Violation ^ ^ APPROPRIATE PERMIT ON HAND ^ UUSIr1t3SS PLAN CONTACT INFORMATION ACCURATE ~~/1 ~ti ~~$f~.Cl ~. R~ w;/ ^ VISIBLE ADDRESS ~ _ ~Y ' ^ CORRECT OCCUPANCY ' VERIFICATION OF INVENTORY MATERIALS n „' ---~.T~`/ ~~, ~/ "yy~~~~JJ ^ . VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION JZ~ , ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY nj !'~ ^ VERIFICATION OF HAZ MAT TRAINING ~ i ~ uV`~ ~ }}} ~~~ \\\~~~'~~I "' I~ ^ VERIFICATION OF ABATEMENT SUPPLIES AND - III --- --- ---- PROCEDU RES ^ EMERGENCY PROCEDURES ADEQUATE _ ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE 8 ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ~NO EXPLAIN. - _ _ . t~ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 328-3879 Inspector (Please Print) Fire Prevention / 1" In / Shift of Site/Station ~ Business Sit9/School Site Responsibi Party (Please Printj White - Prwention Services Yellow -Station Copy Pink - Suainesa Copy FD2048 (Rw. 0E/O5) + EMPIRE SURGERY CENTER =_--____________________________ SiteID: 015-021-002919 + Manager SUE WESTERFELD Location: 4101 EMPIRE DR 130 City BAKERSFIELD CommCode: BFD STA O1 ; EPA Numb: BusPhone: (661) 325-1900 Map 102 CommHaz High Grid: 26D FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title SUE WESTERFELD / ASC'SUPERVISOR SCOTT DOBBS / Business Phone: (661) 325-1900x Business Phone: (661) 325-1900x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact SUE WESTERFELD Phone: (661) 325-1900x MailAddr: 4101 EMPIRE DR 1.30 State: CA City BAKERSFIELD Zip 93309 ' ' S Owner E.r~+ ~ ~ ~ ~ ll~-'gp~c..f CQ~+ ~ne : ( 6 61 3 2 5 -19 0 0 x Address 4101 EMPIRE DR 1.30 ~1 ~1 State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT /~l O Cih a-~-,~C 2 S / n b c..t S c~ r~,..d-d P~ GZ-n /U o rev ~ ~ s ~ `o ~ s ~ ~ b (~.s r ~,_.e ss ~ lr~t.,-~ 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 famil[ar with the information submitted and believe the information is true, accurate, and complete. 3 Signature `" ~~ a G d L Date -1- 02/28/2006 UNIFIED PROGRAM INSPEC710N CHECKLIST `~ SECTION 1 Business Plan and Inventory Program • Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 TPI • (f F 11 '~2F-979 FACILITY NAME ~ INSPECTION DATE INSPECTION TIME ADDRESS PH No. No.o p y f = _-------- _.. . FACILITYCONTACT Business ID Number 15-021- Section 1: Business Plan and Inventory Program ~outine O Combined O Joint Agency OMulti-Agency O Complaint O Re-inspection • ANY HAZARDOUS WASTE ON SITE: ^ YES ~ NO EXPLAIN: • QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT ~GF)'I ~ 32t)-3979 Inspector (Please Print) Fire Prevention 1st-In/Shik of Site White -Environmental Services Yellow - Statbn Copy Business Site Responsible Party (Pleas Print) w S Pink • Business Copy