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HomeMy WebLinkAboutBUSINESS PLAN (2)~~ ALLIANCE SURGERY ~~ ~ 2525 EYE STREET, SUITE A { ~~~~ , ~ 7 ~~ ALLIAI~TCE SURGERY CENTER Manager BETTY DEWOODY Location: 2525 EYE ST A City BAKERSFIELD BusPhone: Map 103 Grid: 30A SiteID: 015-021-002465 CommCode: BFD STA Ol EPA Numb: SIC Code: DunnBrad: (661) 327-5412 CommHaz High FacUnits: 1 AOV: Emergency Contact / Title Emergency Contact / Title BETTY DEWOODY / CHARGE NURSE AMY LOWREY / NURSE Business Phone: (661) 327-5412x Business Phone: (661) 327-5412x303 24-Hour Phone (661) 618-2064x 24-Hour Phone (661) 663-0324x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact ALLIANCE SURGERY CENTER Phone: (661) 327-5412x MailAddr: 2525 EYE ST A State: CA City BAKERSFIELD Zip 93301 Owner WEST COAST SURGERY MANAGEMENT Phone: (661) 327-5412x Address 2525 EYE ST A State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif' d: RSs : No ParcelNo: Emergency Directives: PROG A - HAZMAT ~l y ,~~'~ ls ,l ~ . ~©o~ inquiry of those individua formation, 1 certify 8rased on my i n ,; the resNansiiale for ot~t~..ning ersonally f iaw that i have P under ~enaity o d am fam'sliar with the information e , examined an the information is tru id '?ei~ submitted a iete, accurate, and c ~~~ - .- Dat 'S gnat r - -1- 06/29/2007 .~ F ALLIANCE SURGERY CENTER ~ Hazmat Inventory ~ MCP+DailyMax Order = = SiteID: 015-021-002465 ~ By Facility Unit ~ Fixed Containers at Site ~ Hazmat Common Name... NITROUS OXIDE OXYGEN SpecHazIEPA Hazardsf Frm F P IH G F IH DH G DailyMax Unit MCP 112.00 FT3 Hi 366.00 FT3 Low -2- 06/29/2007 ~P ; ~ ~ -3- 06/29/2007 ~~,~ _ ~, F ALLIANCE SURGERY CENTER SiteID: 015-021-002465 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at $ite ~ COMMON NAME / CHEMICAL NAME NITROUS OXIDE Days On Site 365 Location within this Facility Unit Map: Grid: REAR OF BLDG STORAGE RM CAS# 10024-97-2 ~GasATE ~PureE -~AboveSAmbient AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 450.00 FT3 112.00 FT3 60.00 FT3 I1E~G1itCLVUa wrirvlv~ly-15 %Wt. RS CAS# 100.00 Nitrous Oxide No 10024972 riHGl-itCL H7 ~~J~1•lr,1Vl~ 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: REAR OF BLDG STORAGE RM CAS# 7782-44-7 ~GasATE TpureE -~AboveSAmbEient AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 244.00 FT3 366.00 FT3 165.00 FT3 r11yLJt].CCLVVJ ~vllrvly P~lvla --- %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 11tiGKRL ti~ J J A J Jl•1P~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -4- 06/29/2007 ,: F ALLIANCE SURGERY CENTER SiteID: 015-021-002465 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 05/17/2006 FOR SINGLE PATIENT PROBLEMS: NOTIFY NURSE AND/OR DOCTOR. IF PATIENT RESPONDS BUT NEEDS TRANSPORTATION TO HOSPITAL, DIAL 911 FOR AMBULANCE SERVICE TO TRANSPORT. 9 Employee Notif./Evacuation 05/17/2006 IT IS THE RESPONSIBLITY OF ANY INDIVIDUAL WHO NOTICES A FIRE TO IMMEDIATELY ACTIVATE THE FIRE ALARM SYSTEM BY USING THE MANUAL PULL STATION IN THE WAITING ROOM OR BY THE EMERGENCY EXIT. CHIMES WILL BE HEARD IN THE SUITE AND THE FIRE BELL WILL SOUND IN THE OUTSIDE CORRIDOR. WHEN THE ALARM SYSTEM IS ACTIVATED IT AUTOMATICALLY SIGNALS THE FIRE DEPARTMENT WHICH SENDS A FIRE TRUCK TO THE CENTER. ANY OPERATIVE PROCEDURE CURRENTLY TN PROGRESS WILL BE TERMINATED. THE DOCTOR AND THE CIRCULATING NURSE WILL CONCURRENTLY ASSIST EVACUATION OF THE PATIENT IN THE OPERATING ROOM OR WILL EVACUATE ANY PATIENT IN THE RECOVERY ROOM AREA. THE SCRUB NURSE AND THE ANESTHESIOLOGIST WILL EVACUATE THE PATIENT FROM THE OPERATING ROOM ON A GURNEY. Public Notif./Evacuation 05/17/2006 ~~G~~~~ ~^e (~ Q 11 DIA.L~ON ANY PHONE AND ANNOUNCE THE NEED FOR EVACUATION. REMEMBER TO CALL rO'~LPTERATING ROOM, , 1\L Emergency Medical Plan 05/17/2006 NOTIFY NURSE AND/OR DOCTOR. EVALUATE: DETERMINE NEED FOR TRIAGE. TREAT IF IN AREA OF EXPERTISE. IF YOU NEED PATIENT TRANSFERRED, DIAL 911 AND FOLLOW OUTLINE TO TRANSPORT PATIENT TO HOSPITAL EMERGENCY ROOM. -5- 06/29/2007 ,: ~, - ;-~: F ALLIANCE SURGERY CENTER SiteID: 015-021-002465 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 09/14/2005 ~ MEDICAL GASES BEHIND LOCKED DOORS IN APPROVED CONTAINERS WITH APPROVED MANIFOLDS AND CONTROLS. Release Containment 05/17/2006 OXYGEN AND NITROUS OXIDE ARE USED ON ANETHESIA AND MEDICAL EQUIPMENT IN THE OPERATING ROOMS. EXTRA TANKS ARE STORED IN SEPARATE ROOM IN RACKS OR BEHIND CHAIN. IN THE EVENT GAS WAS LEAKING FROM TANK, BOTH GASES WOULD DISSIPATE INTO THE AIR RAPIDLY WITHOUT INJURY OR HARM. EVACUATION OF THE AREA AS A PERCAUTION. Clean Up 05/17/2006 CLEAN-UP WOULD BE LIMITED TO CHECKING TANKS FOR STABILITY AND TO BE SURE VALVES ARE TURNED OFF. Other Resource Activation -6- 06/29/2007 ii' °rc F .. F ALLIANCE SURGERY CENTER SiteID: 015-021-002465 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~ Special Hazards 09/14/2005 ~ RADIOISATOPES ON HAND RADIATION HAZARD. Utility Shut-Offs 01/24/2007 GAS: SE CRNR W SIDE ELECTRICAL NW CRNR & W SIDE MIDWAY WATER: W SIDE BLDG APPROX 15FT SPECIAL: NO LOCK BOX: NO Fire Protec./Avail. Water 01/24/2007 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS, PARKING STRUCTURE AND BOTH FLOORS OF OFFICE BLDG ARE EQUIPPED WITH SPRINKLERS, AND SHUT-OFF VALVES, FIRE HYDRANT - NW CRNR OF PROP CRNR EYE ST & 26TH ST. Building Occupancy Level 25 EMPLOYEES 02/27/2006 -7- 06/29/2007 ~~_ ~ i' ~a , F ALLIANCE SURGERY CENTER SiteID: 015-021-002465 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/17/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: WE HAVE A SAFETY COMMITTEE CONSISTING OF ONE MEMBER FROM EACH DEPT. THEY IDENTIFY THOSE ITEMS IN THEIR AREA THAT REQUIRE MSDS SHEETS AND INSTRUCT THE EMPLOYEE ACCORDINGLY. FOUR TIMES A YEAR AT OUR GENERAL STAFF MEETINGS THERE IS AN AREA ON SAFETY ON THE AGENDA. rayc ~ nciu tvi ru~uLC ~~c nciu ivi r u~.ui.c u~c -8- 06/29/2007 ~~~ ~~ ~~~ ~/ ~~'~ /~ti~ ,~ f'I ' 1 Q Ln '~~ CITY OF BAKERSFIEI.D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES ~'~ UNIFIED PROGRAM INSPECTION CHECKLIST ;w„"'~~~,~ 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~~~jc.~ StSI~J 6:~~ ADDRESS ZSZS' ~~C~Y~ rt FACILITY CONTACT /j i= ~oO~f INSPECTION TIME ~(? /~1n/ INSPECTION DATE -7~-%J -~ ~ _ PHONE NO. 3 27 - Szt ( 2 BUSINESS (D NO. 15-21U-p04? NUMBER OF EMPLOYEESi~_ __ Section l: Business Plan and Inventory Program ^ Routine Combined ^ Joint Agency ^Mtilti-Agency ^ Complaint ^ Re-inspection OPERATION C V 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 Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain:- Questions regarding this inspection? Please call us at (661) 326-3979 ^ Yes (~No White -Env. Svcs. Yeltow -Station Copy Pink -Business Copy Business ~ttspector:~'~ r _ Y 1 ,, Li \" _ ALLIANCE SURGERY CENTER Manager BETTY DEWOODY Location: 2525 EYE ST A City BAKERSFIELD SiteID: 015-021-002465 BusPhone: (661) 327-5412 Map 103 CommHaz High Grid: 30A FacUnits: 1 AOV: CommCode: BFD STA Ol EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title BETTY DEWOODY / CHARGE NURSE AMY LOWREY / ~ u /s t'- Business Phone: (661) 327-5412x Business Phone: (661) 327-5412x303 24-Hour Phone (661) 618-2064x 24-Hour Phone (661) 663-0324x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact ~-~Lt°tr`~ ~P~~e,^yC,Gy~.'e/ Phone: (661) 327-5412x MailAddr: 2525 EYE ST A State: CA City BAKERSFIELD Zip 93301 Owner WEST COAST SURGERY MANAGEMENT Phone: (661) 327-5.412x Address 2525 EYE ST A State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ENT'p ~~~ z z zoos Ba~~sd on my inquiry of those individuals r®sponsibia for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and be ve the information is true, accurate, and com I te. Q /""' /°~ Sig a ur Date -1- 01/24/2007 ~. F ALLIANCE SURGERY CENTER SiteID: 015-021-002465 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE OXYGEN F P F IH IH DH G G 112.00 366.00 FT3 FT3 Hi Low -2- 01/24/2007 -3- 01/24/2007 F ALLIANCE SURGERY CENTER SiteID: 015-021-002465 ~ ~ 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: REAR OF BLDG STORAGE RM CAS# 10024-97-2 ~GaSATE TYPE T PRESSURE TEMPERATURE CONTAINER TYPE TPure I Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 450.00 FT3 112.00 FT3 60.00 FT3 HAZARDOUS COMPONENTS oWt. RS CAS# 100.00 Nitrous Oxide No 10024972 riEiGEjtC1J I~JJL' S.71~1~1V 1 J 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: REAR OF BLDG STORAGE RM CAS# 7782-44-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas TPure ~-Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 244.00 FT3 366.00 FT3 165.00 FT3 ruyc~tucLV V a ~.vi•irvivnty t ~ - %Wt• RS CAS# 100.00 Oxygen, Compressed No 7782447 i3tiL~ti.CCL ti. 7.7 L' w7 Jl"1L'1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -4- 01/24/2007 F ALLIANCE SURGERY CENTER SiteID: 015-021-002465 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 05/17/2006 FOR SINGLE PATIENT PROBLEMS: NOTIFY NURSE AND/OR DOCTOR. IF PATIENT RESPONDS BUT NEEDS TRANSPORTATION TO HOSPITAL, DIAL 911 FOR AMBULANCE SERVICE TO TRANSPORT. Employee Notif./Evacuation 05/17/2006 IT IS THE RESPONSIBLITY OF ANY INDIVIDUAL WHO NOTICES A FIRE TO IMMEDIATELY ACTIVATE THE FIRE ALARM SYSTEM BY USING THE MANUAL PULL STATION IN THE WAITING ROOM OR BY THE EMERGENCY EXIT. CHIMES WILL BE HEARD IN THE SUITE AND THE FIRE BELL WILL SOUND IN THE OUTSIDE CORRIDOR. WHEN THE ALARM SYSTEM IS ACTIVATED IT AUTOMATICALLY SIGNALS THE FIRE DEPARTMENT WHICH SENDS A FIRE TRUCK TO THE CENTER. ANY OPERATIVE PROCEDURE CURRENTLY IN PROGRESS WILL BE TERMINATED. THE DOCTOR AND THE CIRCULATING NURSE WILL CONCURRENTLY ASSIST EVACUATION OF THE PATIENT IN THE OPERATING ROOM OR WILL EVACUATE ANY PATIENT IN THE RECOVERY ROOM AREA. THE SCRUB NURSE AND THE ANESTHESIOLOGIST WILL EVACUATE THE PATIENT FROM THE OPERATING ROOM ON A GURNEY. Public Notif./Evacuation 05/17/2006 DIAL 80 ON ANY PHONE AND ANNOUNCE THE NEED FOR EVACUATION. REMEMBER TO CALL OPERATING ROOM, EXTENSION 258 OR 270, BECAUSE CALL SYSTEM IS NOT HEARD THERE. Emergency Medical Plan = NOTIFY NURSE AND/OR DOCTOR. IN AREA OF EXPERTISE. IF YO OUTLINE TO TRANSPORT PATIENT 05/17/2006 EVALUATE: DETERMINE NEED FOR TRIAGE. TREAT IF U NEED PATIENT TRANSFERRED, DIAL 911 AND FOLLOW TO HOSPITAL EMERGENCY ROOM. -5- 01/24/2007 t F ALLIANCE SURGERY CENTER SiteID: 015-021-002465 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 09/14/2005 ~ MEDICAL GASES BEHIND LOCKED DOORS IN APPROVED CONTAINERS WITH APPROVED MANIFOLDS AND CONTROLS. Release Containment 05/17/2006 OXYGEN AND NITROUS OXIDE ARE USED ON ANETHESIA AND MEDICAL EQUIPMENT IN THE OPERATING ROOMS. EXTRA TANKS ARE STORED IN SEPARATE ROOM IN RACKS OR BEHIND CHAIN. IN THE EVENT GAS WAS LEAKING FROM TANK, BOTH GASES WOULD DISSIPATE INTO THE AIR RAPIDLY WITHOUT INJURY OR HARM. EVACUATION OF THE AREA AS A PERCAUTION. Clean Up 05/17/2006 CLEAN-UP WOULD BE LIMITED TO CHECKING TANKS FOR STABILITY AND TO BE SURE VALVES ARE TURNED OFF. V1.11C1 1CC~7VULl,:C L'ilrL1VCLL1V11 -6- O1/24f2007 F ALLIANCE SURGERY CENTER SiteID: 015-021-002465 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~ Special Hazards 09/14/2005 ~ RADIOISATOPES ON HAND RADIATION HAZARD. Utility Shut-Offs 01/24/2007 GAS: SE CRNR W SIDE ELECTRICAL NW CRNR & W SIDE MIDWAY WATER: W SIDE BLDG APPROX 15FT SPECIAL: NO LOCK BOX: NO Fire Protec./Avail. Water 01/24/2007 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS, PARKING STRUCTURE AND BOTH FLOORS OF OFFICE BLDG ARE EQUIPPED WITH SPRINKLERS, AND SHUT-OFF VALVES, FIRE HYDRANT - NW CRNR OF PROP CRNR EYE ST & 26TH ST. Building Occupancy Level 02/27/2006 25 EMPLOYEES -7- 01/24/2007 `~ - 'c F ALLIANCE SURGERY CENTER SiteID: 015-021-002465 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/17/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: WE HAVE A SAFETY COMMITTEE CONSISTING OF ONE MEMBER FROM EACH DEPT. THEY IDENTIFY THOSE ITEMS IN THEIR AREA THAT REQUIRE MSDS SHEETS AND INSTRUCT THE EMPLOYEE ACCORDINGLY. FOUR TIMES A YEAR AT OUR GENERAL STAFF MEETINGS THERE IS AN AREA ON SAFETY ON THE AGENDA. ra~c ~. Held for Future Use raciu tvt ru~.ui.c vac -8- 01/24/2007 + ALLIANCE SURGERY CENTER _____________________________ SiteID: 015-021-002465 + Manager BETTY DEWOODY BusPhone: (661) 327-5412 Location: 2525 EYE ST A Map 103 CommHaz High City BAKERSFIELD Grid: 30A FacUnits: 1 AOV: CommCode: BFD STA O1 SIC Code: EPA Numb: DunnBrad: +___________________________________________________________________________===t Emergency Contact / Title Emergency Contact / Title BETTY DEWOODY / CHARGE NURSE AMY LOWREY / Business Phone: (661)~.s~327-.5'~~ Business Phone: (661) 327-5412x303 24-Hour Phone (661) 618-2064x 24-Hour Phone (661) 663-0324x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth _ _ Contact Phone: (661) 327-5412x MailAddr: 2525 EYE ST A ~ State: CA City BAKERSFIELD Zip 93301 Owner WEST COAST SURGERY MANAGEMENT Phone: (661) 327-5412x Address 2525 EYE ST A State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers ~ TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: ~ Emergency Directives: ~ ~~~ PROG A - HAZMAT ~ ~ ~ ~ 1 Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law 4hat I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complet Signature ~/f ~~~ Date f Nip ~U~ 2 4 2~~6 ~'`0°0.~ _ 5~ -1- 05/17/2006 ~foR~ ~ UNIFIED PROGRAM INSPECTION CHECKLISTI _._~=.~ SECTION 1: Business Plan and Inventory Program ~ i Prevention Services B >? R s F _, _D 900 Truxtun Ave., Suite 210 FARE Bakersfield, CA 93301 ARTM r Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME 9 ~ ~;- ,- INSPECTION DATE a INSPECTION TIME ADDRESS ~ -a J ~ PH NE 0. ~ NO OF EMPLOYEES a FACILITY CONTACT ~~ -cam (NESS ID NUMBER [~ /_ ~Z7 x,215-021- a-G (~J~ Section 1: Business Plan and Inventory Program ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS - / 1~ ^ APPROPRIATE PERMIT ON HAND ^ BUSif1eSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS lLd~ l~ VERIFICATION OF QUANTITIES , ^ VERIFICATION OF LOCATION ,,, / IIY, ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ~ ^ VERIFICATION OF HAZ MAT TRAINING O, / I J' ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES y / lf~ ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE 8 ON HAND - ANY HAZARDOUS WASTE ON SITE? ^ YES C~1~0 nnr-ouio EXPLAIN QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~d~ .e~w~ ~~~~ i~ Inspector (Please Print) Fire Prevention / 1s` In /Shift of Site/Station # Bu mess ite Rep ible (Please Print) - White -Prevention Services Yellow -Station Copy Pink--Business Copy - ~ FD 2155 (Rev. 09/05 • .] ~` '~~'' CITY OF BAKERSFIELD FIRE DEPARTMENT b~ OFFICE OF ENVIRONMENTAL SERVICES y. UNIFIED PROGRAA'I INSPECTION CHECKLIST ,W ~4ti/~r~ 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME/l; g ~-e:~P Su /'a f.. Cam/: INSPECTION DATE s' 3-~ 6 ADDRESS- 2s ~ s ~~' ~~ ~ PHONE NO. f ~ -evdr FACILITY CONTACT i4ivl y Lbw2EY BUSINESS ID NO. 15-210- INSPECTION T1ME~ /o ; ~o NUMBER OF EMPLOYEES-- ~~ Section 1: Business Plan and Inventory Program ,~ Routine ^ Combined ^ Joint Agency ^Mutti-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities v ~~~ 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 Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: ^ Yes ^ No • Explain: Questions regarding this inspection'' Please call us at (661) 326-3979 White -Env. Svcs. Yellow -Station Copy Pink -Business Copy Inspector=~%~~-,