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HomeMy WebLinkAboutBUSINESS PLAN1 // ~ ~ i I ~f~, , ~ _ iii ) \\ G 'l `~' l~' ,~ ,1 ~~ -~~ ---- ''1 `` SAN JOAQUIN COMM HOSP 2615 EYE STREET 35-3 , ~ (~~nv.c ee-~ ~ ~~~ ~ \b -~ _ o _ __, ~ ~ ~~4~J ~, 5 ~ ~~ ~ J _. _. _ .. .. _~5.. -_ _... _. y ,~.t~ • FIRE PREVENTION INSPECTION >I EF,1Rel `° ARTM f BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 ^ Fax: (66 852-2171 ai DISTRICT BLOCK NO. DATE - ^, T'~ -7 „/ EE ^ ~. _ FACILITY ADDRESS ~~ ~ ~ CITY, STATE, ZIP ~~ ~ /~ / l _ FACILITY NAME ~,~ _~ `/ ~ ~ f ~~( MANAGER'S NAME ~ FACILITY PHONE NO. BUSINESS OWNER'S NAME AND ADDRESS ~ r ~ CITY, STATE, ZIP ~/' OWNER'S PHONE NO. BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, ZIP, ~ /BILLING PHONE NO. OCC Ta:P_E °r",,,,~..,,, OCC LOAD ~ NO. OF FLO HIG/H RISE BLDG RISER DATE ,YES `-'~ ` NO CORRECT ALL VIOLATIONS VIOLATION CHECKED BELOW No. REQUIREMENT ~' COMBUSTIBLE WASTE/DRY 1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.) VEGETATION 2 Provide non-combustible containers with tight fitting lids for the storage of combustible waste and rubbish pending its safe disposal. (U.F.C.) COMBUSTIBLE STORAGE 3 Relocate combustible storage to provide at least 3 feet clearance around motor fuse box/fire door (N.E.C.) (U.F.C.) 4 Relocate fire extinguisher(s) so that they will be in a conspicuous location, hanging on brackets with the top to the extinguisher not more than 5 feet above the floor. (N.F.P.A. No. 10) .. •v EXTINGUISHERS 5 Provide and install (amount) _____ approved (type & size) _____ _____ portable fire extinguisher to be immediately accessible for use in (area) _____________________________ (U.F.C.) g Re-charge all fire extinguishers. Fire extinguishers shall be serviced at least once each year, andtor after each use, by a person having a valid license or certificate. (U.F.C.) SIGNS 7 Provide and maintain "EXIT" sign(s) with letters 5 or more inches in height over each required exit (door/window) to fire escape. (U. F. C.) g Provide and maintain appropriate numbers on a contrasting background and visible from the street to indicate the correct address of the building. (B. M.C.) (U. F. C.) FIREDOORSI FIRE SEPARATIONS y Repair all (cracks/holes/openings) in plaster in (location) _____ _________________. Plastering ---------- shall return the surface to its original fire resistive c 10 Remove/repair (item & location) _________________ __ _____ ______ _____ ______________. Self-closing doors shall be designed to close by gravity, or by the action of a mechanical device, or by an approved smoke and heat sensitive device. Self-closing doors shall have no attachments capable of preventing the operation of the closing device. (U.F.C.) EXITS 11 Remove all obstruction from hallways. Maintain all means of egress free of any storage. (U.F.C.) 12 Provide a contrasting colored and permanently installed electric light over or near required exit (location) ______________________________ to clearly indicate it as an exit. (U.F.C.) STORAGE 13 Remove all storage andtor other obstructions from fire escape landings and stairways stair shafts. (Fire escapes/stair shafts are to be maintained free from obstructions at all times.) (U.F.C.) ELECTRICAL APPLIANCES 14 Extension cords shall not be used in lieu of permanent approved wiring. Install additional approved electrical outlets where needed. (N.E.C.) (U. F. C.) 15 Remove multiple attachment cords from specific electrical convenience outlet (one plug per outlet) (N.E.C.) (U.F.C.) ouTDOORBURNING 16 Violation of Section 1102 dealin with recreational fires or o en burnin U.F.C. FIREWORKS 17 Violations of Section 7802' U.F.C or 8.49.040 of the Bakersfield Munici al Co a B.M.C. re ardin fireworks. OTHER 18 / CUSTOMER: ~~ ~ ~~ (Sign tore) (Please Print ame Legibly~itle) n R,,.-- INSPECTOR: I ,~% A. ~~! '+'/ ~ P NO.: (Signature LEGEND: C.F.C. CALIFORNIA FIRE CODE U.B.C. UNIFORM BUILDING CODE B.M.C. BAKERSFIELD MUNICIPAL CODE N.F.P.A. NATIONAL FIRE PROTECTION ASSOCIATION N.E.C. NATIONAL ELECTRIC CODE 1 1 White -Customer/Original Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09/05) STATE FIRE MARSHAL FIRE SAFETY INSPECTION REQUEST `777-~~~ c,, COPY DIS-, .:BUTION 1.3•STATL FIRE MARSHAL SEE REVERSE OF COPIES 2 AND 5 FOR INSTRUCTIONS FOR COMPLETION STD 850 (REV 8/86) 2-FIRE AUTHORITY 1. REQUEST DATE 2. PROGRAM 4-5•LICENSING AGENCY 01/24/2005 050455 3. AGENCY CONTACT 4. TELEPHONE N0. 5. EVALUATOR Cheryl Fuller, AGPA (661) 336.0543 Barbara Mellor, DA 6. SFM REGION 7. SFM T.D. N0. 8. REQUESTING AGENCY FACILITY N0. 9. REQUEST CODE SOUTHERN 0000187 lA CODES Department of Health Services 1. ORIGINAL A. FIRE CLEARANCE 10. AGENCY Licensing and Certification 2. RENEWAL B. LIFE SAFETY NAME Bakersfield District Office 3. CAPACITY CHANGE AND 1200 Discovery Plaza, Suite 120 4. OWNERSHIP CHANGE ADDRESS Bakersfield, CA 93309 5. ADDRESS CHANGE 6. OTHER 11. AMBULATORY NON AMBULATORY TOTAL CAP. DATE OF LAST FIRE CLEARANCE CAPACITY AGE RANGE (Y RS) PREVIOUS CAPACITY AGE RANGE (Y RS) PREVIOUS 06/09/1999 TO 18 18 TO 65 AND CAPACITY TO 18 18 TO 65 AND CAPACITY 19. FACILITY 65 OVER 65 OVER CODE 178 0 0 0 0 0 0 0 0 0 178 02 12. FACILITY NAME 13. N0. BLDGS CODES SAN JOAQUIN COMMUNITY HOSPITAL 1 1. SNF 10. HHA 14. STREET ADDRESS (ACTUAL LOCATION) 15. RESTRAINT 2• GACH 11. ADHC 3. CDRH 12. ICFDDN 2615 EYE STREET 4. SPHOSP 13. CLINICS CITY ZIP CODE 16. HOURS 5. 6. APH 14. REFRLAG PHF 15. UNLICEN BAKERSFIELD, CA 93301 24 7. ICF 16. JAIL 17. FACILITY CONTACT PERSON TELEPHONE N0. 16A. SPECIAL 8. 9. ICFDD 17. OTHER ICFDDN ROBERT BEEHLER (661) 395.3000 SPECIAL INSTRUCTIONS: Facility adding five story tower, increase in bed capacity/services. TO BE COMPLETED BY IN SP THORITY 18. FIRE 1 ~ ~~ ~r /~ ~ AUTHORITY ~p, / --~ (~~ 'GQ 26. CLEARANCE ODE NAME t~~~-~Y 5 / " ~ , }} ~ `'~ ~~ ~ `~ CODES. ADDRESS / ~ ~ ~ V v n 1 n n ~ 2. IRE CLEAR. GRANTED FIRE CLEAR. DENIED (^~ ~ ' ~ L ~tl t `~ ~ O 3. FIRE CLEAR. WITHHELD ~ ~~ 1 27. DENIAL CODE TO BE COMPLETED BY INSPECTING AUTHORITY CODES 21. INSPEC~.QR'S N E ~C~~L~L T PHONE 0. 6 1 -•~ ~ o< 22. CFIRS ID N0. ~ /'j\ 7VV 23. T-19 OCC. Cl~$$. `" I ~-L 1. 2. 3. EXITS CONSTRUCTION FIRE ALARM 24. INSP. DATE ~~~ 25. INSPECTO IG RE 4. 6. SPRINKLERS SPECIALEPHAZARD 28. EXPLAIN DENIAL OR LIST SP IAL CONDITIONS STATE FIRE MARSHAL USE ONLY 20. REGION Department of Health Services/Life Safety Unit OFFICE 464 West 4th Street, Suite 529 AND San Bernardino, CA 93401 ADDRESS ~.ldventist Health San Joaquin Community Hospital September 5, 2006 Bakersfield City Fire Department Station One Attention: Captain 2101 H Street Bakersfield, California 93301 - 2615 Eye Street P.O. Box 2615 Bakersfield, CA 93303-2615 661-395-3000 RE: July 4th Response to San Joaquin Community Hospital Fire in Laundry Room First, we would like to thank you for your prompt response to our fire alarm on July 4, 2006. Your response and suggestions for improvement were very much appreciated. We would like to inform you that we have made numerous changes to our laundry process at the hospital. These include: In depth training of all staff responsible for dryer use Thorough cleaning.of all_dryer and wall vents Replacement_of exhaust duct work above the ceiling Replacement of metal exhaust from dryer to larger exhaust duct work above the ceiling Posting of filter cleaning log -for employee signatures We no longer use the cut up rags that tend to cause more lint We would like to assure you that this incident was taken very seriously by hospital staff and that we will continue to monitor these changes and work on further improvements in our laundry process as needed. Once again, thank you for your reponse and assistance. Sincerely, ~~-~ ~. Alethia Ragle, . Director. Environmental.Serivices/Safety . cc: Dave Weirather Ralph Huey JOB CARD POST CARD AT JOB SITE INSPECTION RECORD-USTs ~„ B H R 8 P 1 b P/Ifi! ~Rr~ r BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979. Fax: (661) 852-2171 Page 1 of 1 FACILITY OWNER 11 ~ c, r N 65 ADDRESS ~ IS ~ c S 1 ADDRESS _ S CITY STATE ZIP 3 I CffY ~ T TE ZI BAKERSFIELD CA © cS PHONE N0. ~~ ~ -' ` ~ 1 PERMIT NO. ,~ - f ` / ; INSTRUCTIONS: PLEASE CALL FOR AN INSPECTOR ONLY WHEN EACH GROUP OF INSPECTIONS WITH THE SAME NUMBER ARE READY. THEY WILL RUN IN CONSECUTIVE ORDER BEGINNING WITH NUMBER 1. D N T COVER WORK FOR ANY NUMBERED GROUP UNTIL ALL ITEMS IN THAT GROUP ARE SIGNED OFF BY THE PERMITTING AUTHORITY. FOLLOWING THESE INSTRUCTIONS WILL REDUCE THE NUMBER OF REQUIRED INSPECTION VISITS AND THEREFORE PREVENT ASSESSMENT OF ADDITIONAL FEES. INSPECTION DATE INSPECTOR TANKS AND BACKFiLL _ BACKFILL OF TANK(S) SPARK TEST CERTIFICATION OR MANUFACTURES METHOD CATHODIC PROTECTION OF TANK(S) PEP NG SYSTEIN PIPING 8~ RACEWAY W/COLLECTION SUMP ~ ~D 1, Q(~, CORROSION PROTECTION OF PIPING, JOINTS, FILL IPE ELECTRICAL ISOLATION OF PIPING FROM TANK(S) CATHODIC PROTECTION SYSTEM-PIPING DISPENSER PAN SECONDARY CONTAINMENT, OVERFILL PROTECT ION, LEAK DETECTION LINER INSTALLATION -TANK(S) LINER INSTALLATION -PIPING VAULT WITH PRODUCT COMPATIBLE SEALER LEVEL GAUGES OR SENSORS, FLOAT VENT VALVES PRODUCT COMPATIBLE FILL BOX(ES) PRODUCT LINE LEAK DETECTOR(S) LEAK DETECTOR(S) FOR ANNUAL SPACE-D.W. TANK(S) MONITORING WELL(S)/SUMP(S) - H2O TEST LEAK DETECTION DEVICE(S) FOR VADOSE/GROUNDWATER SPILL PREVENTION BOXES FINAL MONITORING WELLS, CAPS & LOCKS FILL BOX LOCK MONITORING REQUIREMENTS TYPE AUTHORIZATION FOR FUEL DROP CONTRACTOR L` !t l ' t ~~ 1 lC Y_~U ~I~ i~LC 1AT LICENSE NO. ~ S~1I ©~ CONTACT ~DS ~ Ol' I~N'COl`{ PHONE NO. 3~. ! -~1.3~I FD 2097 (Rev. 09!05) ~, ~.` . ' ,. Wallace~& Smith ~' :..GENERAL ~CONTRACTO,RS; , _ - Carl thetford ~ . '~`. M , _ -Project Superintendent .-•, . ,. cell: (661) 979-3748 , 3325 Candco Drive, Bakersfield; CA 93308' . ~. i _ Phone: (661) 327 ;1436; Fax: (661) 327-8865 License Number 481999, A California Corporatfori ~. - , s E R s F I n June 1, 2006 F/RE A l~ TM T Mr. Bob Easterday San Joaquin Community Hospital 2615 Eye Street Bakersfield, CA 93301 CLOSURE OF ONE (1) UNDERGROUND STORAGE TANK Ronald J. Froze SAN JOAQUIN COMMUNITY HOSPITAL Fire Chief 2615 EYE STREET PERMIT # TR-0331 Gary Hutton Senior Deputy Chief Administration Dear Mr. Easterday: 326-3650 Deputy Chief Dean Clason Thls is to inform yot~ that this department has reviewed the Operations/Training reSUItS for the preliminary assessment associated with the 326-3652 abandonment-in-place of the 15,000 gallon former diesel generator fuel underground storage tank on April 15, 2005 at the above Deputy Chief Kirk Blair ~ referenced address. Fire Safety/Prevention Services 326-3653 Based upon laboratory data submitted, this office is satisfied 2101 ~°x°° street with the assessment performed and requires no further action at this Bakersfield, cA 93301 ' time. Accordingly, no unauthorized release reporting is necessary (661} 326-3941 for this closure. (661) 852-2170 (fax) Prevention services If you have any questions regarding this matter, please contact Ralph Huey, Director me at (661) 326-3979. 900 Truxtun, Suite 210 Bakersfield, CA 93301 Sincerely, (bbl) 326-3979 RALPH E. HUEY (bbl} 852-2171 (fax) Director of Prevention Services David Weirather By' Fire Plans Examiner Howard Wines c`;'~,.rr{~~ ~ ~ _ L.=-- Hazardous Materials Specialist Howard H. Wines, III Hazardous Materials Specialist professional Geologist No. 7239 HHW/s "Sexur~ f.Pie tan ./12a~e /`~%aii CZ L~~f ~" -~. _-- r; x ~ r i ll June 1, 2006 F/RE A R TM T Mr. Bob Easterday San Joaquin Community Hospital 2615 Eye Street Bakersfield, CA 93301 CLOSURE OF ONE (1) UNDERGROUND STORAGE TANK Ronald J. Froze SAN JOAQUIN HOSPITAL -FORMER VACANT LOT Fire Chief NORTHEAST CORNER OF 29th STREET & CHESTER AVE. PERMIT # BR-0326 Gary Hutton Senior Deputy Chief Administration Dear Mr. Easterday: 326-3650 Deputy Chief Dean Clason Operations/Training , 326-3652 Deputy Chief Kirk Blair Fire Safety/Pzevention Services 326-3653 2101 "H" Street Bakersfield, CA 93301 (661) 326-3941 (661) 852-2170 (fax) Prevention Services Ralph Huey, Director 900 Truxtun, Suite 210 Bakersfield, CA 93301 (661) 326-3979 (661) 852-2171 (fax) David Weirather Fire Plans Examiner Howard Wines Hazardous Materials Specialist This is to inform you that this department has reviewed the results for the preliminary assessment associated with the removal of the previously abandoned 5,000 gallon underground storage tank on May 27, 2004 at the above referenced address. Based upon laboratory data submitted, this office is satisfied with the assessment performed and requires no further action at this time. Accordingly, no unauthorized release reporting is necessary for this closure. If you have any questions regarding this matter, please contact me at (661) 326-3979. Sincerely, RALPH E. HUEY birector of Prevention Services By: Howard H. Wines, III Hazardous Materials Specialist Professional Geologist No. 7239 HHW/s "Sez ffe ~ sires ..~I2'ane J`~~irii CZC'c~u~r~" E R S F I D June 1, 2006 F/RE I~ R TM T Mr. Bob Easterday San Joaquin Community Hospital 2615 Eye Street Bakersfield, CA 93301 CLOSURE OF ONE (1 }UNDERGROUND STORAGE TANK Ronald J. Froze SAN JOAQUIN HOSPITAL -FORMER VACANT LOT Fire Chief NORTHEAST CORNER OF 28th STREET & CHESTER AVE. PERMIT # BR-0296 Gary Hutton Senior Deputy Chief Administration Dear Mr. Easterday: 326-3650 Deputy Chief Dean Clason Operations/Training 326-3652 Deputy Chief Kirk Blair Fire Safety/Prevention Services 326-3653 2101 "H" Street Bakersfield, CA 93301 (661) 326-3941 (661) 852-2170 (fax) Prevention Services Ralph Huey, Director 900 Truxtun, Suite 210 Bakersfield, CA 93301 (661) 326-3979 (661) 852-2171 (fax) David Weirather Fire Plans Examiner Howard Wines Hazardous Materials Specialist This is to inform you that this department has reviewed the results for the preliminary assessment associated with the removal of the previously abandoned 7,500 gallon underground storage tank on January 24, 2003 at the above referenced address. Based upon laboratory data submitted, this office is satisfied with the assessment performed and requires no further action at this time. Accordingly, no unauthorized release reporting is necessary for this closure. 1f you have any questions regarding this matter, please contact me at (661) 326-3979. Sincerely, RALPH E. HUEY birector of Prevention Services By: 1 , r~ / ~~ ----_ C ?tst,-- ~ ` r~i` -`-.~ . Howard H. Wines, III Hazardous Materials Specialist professional Geologist No. 7239 HHW/s FIRE ORDINANCE VIOLATION A 0078 ~l ~1 a a it s P I T FIRE AIiTM T _... BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: 661) 852-2101 OCCUPANCY DISTRICT BLOCK NO. ATE ~ O~ TO~~~~/ lml~ G J TITLE ~~~ ~ ,~~„r C~L i X17-(e-T-~-u2fl IRM OR DBA ~,' ~/~nJ -~~Qu,.J ~ E p, s~~ COMPANY ADDRESS (CITY, STATE, ZIP) r7 / i ~ /~/ 5,~ C'l~ v C.• USINESS PHONE„~Z„~ _ +~ OME PHONE CORRECT ALL REQUIREMENTS VIOLATIONS VIOLATION COMBUSTIBLE WASTE /DRY 1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.) VEGETATION 2 , Provide non-combustible containers with tight fitting lids for the storage of combustible waste and rubbish pending its safe disposal. (U.F.C.) COMBUSTIBLE STORAGE 3 Relocate combustible storage to provide at least 3 feet clearance around motor fuse box/fire door (N.E.C.) (U.F.C.) 4 Relocate fire extinguisher(s) so that they will be in a conspicuous location, hanging on brackets with the top to the extinguisher not more than 5 feet above the floor. (N.F.P.A. No. 10) EXTINGUISHERS 5 Provide and install (amount) _____ approved (type & size) __________________ portable fire extinguisher to be immediately accessible for.use in (area) _____________________________ (U.F.C.) g Re-charge all fire extinguishers. Fire extinguishers shall be services at least once each year, and/or after each use, by a person having a valid license or certificate. (U.F.C.) 7 Provide and maintain "EXIT" sign(s) with letters 5 or more inches in height over each required exit SIGNS (door/window) to fire escape. (U.F.C.) g Provide and maintain appropriate numbers on a contrasting background and visible from the street to indicate the correct address of the building. (B.M.C.) (U.F.C.) g Repair all (cracks/holes/openings) in plaster in (location) ______________________________________. FIRE DOORS/ FIRE SEPARATIONS Plastering shall return the surface to its original fire resistive condition. (U.B.C.) 10 Remove/repair (item & location) _________________________________________________________. Self-closing doors shall be designed to close by gravity, or by the action of a mechanical device, or by an approved smoke and heat sensitive device. Self-closing doors shall have no attachments capable of preventing the operation of the closing device. (U.F.C.) EXITS 11 Remove all obstruction from hallways. Maintain all means of egress free of any storage. (U.F.C.) 12 Provide a contrasting colored and permanently installed electric light over or near required exit (location) ______________________________ to clearly indicate it as an exit. (U.F.C.) STORAGE 13 Remove all storage and/or other obstructions from fire escape landings and stairways stair shafts. (Fire escapes/stair shafts are to be maintained free from obstructions at all times.) (U.F.C.) 14 Extension cords shall not be used in lieu of permanent approved wiring. Install additional approved ELECTRICAL APPLIANCES electrical outlets where needed. (N. E.C.) (U.F.C.) 15 Remove multiple attachment cords from specific electrical convenience outlet (one plug per outlet) (N.E.C.) (U.F.C.) OUTDOOR BURNING ig Violation of Section 1102 dealing with recreational fires or open burning. (U.F.C.) FIREWORKS 17 Violations of Section 7802 (U.F.C.) or 8.49.040 of the Bakersfield Municipal Code (B.M.C.) regarding fi reworks . OTHER 18 p ~ ^~ 1 ~/'~~1.. C~PL~-'it= US`~ ~•..C-~yYAt QC~`'+ t`~ LIU{~TIU~ MaKe n!L-+:~-sSA24~ ,,~./taFJLI~'~ Fcxc- P?~Pi'2 ~v~lae- I ~ AN ENFONRCEMENT ORIDERNWILLEG SENOB OCER OF ED M ALEPRO DENG A HEA ING DATE. ~~ yERS~ECE~ING ICE OF VK)LATK)N I N URE AFTER VIOLATIONS ARE CORRECTED, RETURN THIS BY ORDER OF THE FIRE CHIEF DATE COMPLETED: NOTICE BY MAIL OR IN PERSON TO: ^ ~ ~, v l~ BAKERSFIELD FIRE DEPT INSPECToR SIGNATURE INSPECTOR SIGNATURE . OFFICE OF PREVENTION SERVICES LEGEND: C.F.C. CALIFORNIA FIRE CODE 900 TRUXTUN AVE., SUffE 21D U.B.C. UNIFORM BUILDING CODE BAKERSFIELD CA 93301 B.M.C. BAKERSFIELD MUNICIPAL CODE , N.F.P.A. NATIONAL FIRE PROTECTION ASSOCIATION N.E.C. NATIONAL ELECTRIC CODE White -Customer/Original Yellow -Station Copy Pink -Prevention Services FD1916 IREV. o2iosl UNDERGROUND STORAGE TANKS UNIFIED PROGRAM CONSOLIDATED FORMS H H R S F I D APPLICATION (FORM) wise CLOSURE CERTIFICATION w_ Rr~! r Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (661)326-3979 Fax: (661) 852-2171 Pape 1 of 1 I. FACILITY INDENTIFICATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 PERMIT NO. ~ ~nl Jc~~J~~ --~.~SP~~~z g 3 3 t TANK OWNER NAME Tao TANK OWNER ADDRESS 7a1 ~~ ~ ~ v'~L~ ~~ TANK OWNER CITY 7a2 STATE 743 ZIP CODE 7aa II. TANK CLOSURE INFORMATION Tank ID No Concentration of Flammable Va or Concentration of Oxygen (Attach additional copies of this page Top Center Bottom Top Center Bottom TANK for more than three tanks.) INTERIOR 1 745 746a 746b 746c 747a 747b 747c ATMOSPHERE h lam.-.S~-L p © ~ (~ ~~ ~S ~ ~L~. READINGS 748 749a 749b 749c 750 750b 750c 2 751 752a 752b 752c 753 753b 753c 3 754 754a 754b 754c 75s 756b 756c 4 III. CERTIFICATION On examination of the tank, I certify the tank is visually free from product, sludge, scale (thin, flaky residual of tank contents), rinseate and debris. I further certify that the information provided herein is true and accurate to the best of my knowledge. SIGNATU OF CERTIFIER 1~. STATUS OR AFFILIATION OF CERTIFYING PERSON ^-r Certifier is a representative of the CUPA, authorized agency, or LIA: NAME OF CERTIFIER (Print) 7sa ^ Yes ^ No ~~ ~~ ~ r~-S 7so or LIA: 7s1 Name of CUPA authorized agency TITLEOFCERTIFIER 755 , City of Bakersfield Fire Department ~2 1~r>'r SFCt~rktl5'r Office of Environmental Services ADDRESS 7ss If certifier is other than CUPA /LIA check appropriate box below: 7s2 900 Truxtun Ave., Ste. 210 ^ a. Certified Industrial Hygienist (CIH) CITY 757 ^ b. Certified Safety Professional (CSP) Bakersfield , CA 93301 ^ c. Certified Marine Chemist (CMC) ^ d. Registered Environmental Health Specialist (REHS) PHONE 7sa ^ e. Professional Engineer (PE) (661) 326-3979 ^ f. Class II Registered Environmental Assessor ^ g Contractors' State License Board licensed contractor (with DATE 7ss /, /t S v~ CERT~ ICATIONTIME . hazardous substance removal certification) TANK PREVIOUSLY HELD FLAMMABLE OR COMBUSTIBLE MATERIALS ~es ^ No 7s3 (If yes, the tank interior atmosphere shall be re-checked with a combustible gas t dicator prior to work being conducted on the tank.) CERTIFIER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER, DISPOSAL FACILITY, ETC: 7sa A copy of this certificate shall accompany the tank to the recycling /disposal facility and be provided to the CUPA. If there is no CUPA, copies shall be submitted to the LIA and authorized agency; owner / operator of the tank system; removal contractor; and the recycling /disposal facility. FD 2062c UNDERGROUND STORAGE TANK PERMIT APPLICATION FOR REMOVAL OF AN UNDERGROUND STORAGE TANK Permit No:~~b3?j B H H 8 P 1 D fIR~ r BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (661)326-3979 Fax: (661) 852-2171 Page 1 of 1 SITE INFORMATION SITE DDRESS ZIP CODE FACILITY NAME O CROSS STREET 27 ST . TANKOWNER/OPERATOR PHONE N0.~6~ _ ~ ~~ APN MAILING ADDRESS .~ ` (S ~ Icy ~ S ~ ~ CITY Q ~~S (~i 1 -~` ZIP CODE9~~ CONTRACTOR INFORMATION COMPANY HL _ C PHONE NO. ~7~ n - 1 '"' l LICEN ENO. ADDRESS --~ ~ ~ `~ J Y uL CITY ZIP ODE as INSURANCECARRIER S ~~ ; ~ tel.( ~ ~ PRELIMINARY-ASSESS WORKMENS COMP NO. _ - _ -__. __ J72Tf 6~~ MENT INFORMATION _- _ .------_ -.-- ..__- _ COMPANY PHONE NO. LICENSE N0. ADDRESS CITY ZIP CODE INSURANCECARRIER WORKMENS COMP NO. TANK CLEANING INFORMATION COMPANY e ,~ ~ - r1 a.ll e. ~ ~c~,c~~ m ~ PHONE NO. 2 - ~ 1 LICENSE NO. ~ n ADDRESS 5~d G-tl ~ v CITY ~ t=L ZIP CODE ~~ INSURANCECARRIER S..~A ` ~ ~~ V Om WORKMENS COMP No. I ~ ~~ s d WASTE TRANSPORTER IDENTIFICATION NUMBER FACILITY IDENTIFICATION NUMBER NAME OF RINSATE DISPOSAL FACILITY O - d0 y f ADDRESS rLG('~U At-ED~t EDA 5'T' • CITY Ca m p ~ ~ ~ - -- -__---------- -- --- -- - ------ - _- ._.. _ - - - . _ -- _. .. _ - - -- ---- TANK TRANSPORTER INFORMATION ZIP~ODE -- _0222__.. __ . COMPANY ..`A ~ ..-. ~ ~ -~ PHONE NO. LICENSE NO. ADDRESS Lac CITY ZIP CODE TANK DESTINA ION TANK INFORMATION CHEMICAL DATES TANK NO. AGE VOLUME STORED STORED CHEMICAL PREVIOUSLY STORED For Official Use Only APPLICATION DATE FACILITY No. No. OF TANKS FEE $ THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. ~ APPLICANT NAME (PRINT) ~M~c:z,~~ e S ~- ~~ z~ PLIC TSIGNATURE APPF# ~VED BY - ...,~, THIS APPLICATION WI BECOME A PERMIT WHEN APPROVED AZ. FD ZOF)Z (Rev. 02/05 UNDERGROUND STORAGE TANK INSPECTION FORM TANK REMOVAL B H R 9 P 1 D f/RQ wRTN T Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (661)326-3979 Fax: (661) 852-2171 Pace 1 of ] AGILITY ~ J~~~ ~P~-r4~ DDRESS Z~ ~.5~ C--;- s ~ WNER PERMIT TO OPERATE NO. ONTRACTOR ~ /IkL.C.L'Y ONTACTPERSON ~`~'v S ryG/'~w AB ATORY ~ .~~~ NO.OF SAMPLES ES ETHOD OGY RELIMINARY ASSESSMENT CO. ONTACT PERSON O. RECIEPT LEL% 2% ~~ PLOT PLAN s ~ ~ _ ! _ _ + v5T ; U ~-~~lG~tli*uQ U c~~~~ E-t~s,P ~ ~~- R LO~- ONDITION OF TANKS -S/~n/~~C~ I~cJ ~c.~-cam= - c~'~~c.~ riD D3Se~vC- ONDITION OF PIPING ~: / ONDITION OF SOIL t/ OMMENTS ~d l L S~C~ ~- ~ c,~ ~uC ti ~ ~ Ccrr ~J vc ~-~ '~ Y ,~G-c~.= ;3cm~ ~~.-- ATE INSPECTORS NAME IGNATURE FD2062b 9:00 AM 2615 Eye St. Spoke with Carl Thetford, Supt. for Wallace & Smith. I thought this was the tank abandonment job. I told Carl these tanks don't need to be abandoned in place, they should be removed. I said something like, "Let's get them out of here." Then I said the permit doesn't specify two tanks, just one 15,000 gallon UST. Then I thought, "Wait a minute, there's got to be another tank for the backup generator." Told him a UST removal permit is required for these tanks. The fee would be $655 per tank. I checked the tanks with the CGI. The east tank showed 1 %LEL, west tank 0 LEL. I told Carl he could continue to remove the overburden of the USTs and that I could be available that day if need be to witness the removal once he got the permit. I explained where our office was and gave him a business card. I then walked to the other side of the hospital to where the other tank abandonment was occurring. 11:30 AM. Tanks had been removed and placed next to excavation. Bottom of excavation had been dug for soil samples. I called Delores and asked if a permit had been taken out for these tanks. She said yes, only 5 minutes ago and that it was mostly incomplete and not yet approved, but it was paid for. I got a phone msg. later on that day from Dane Frary, Krazan & Assc. saying he performed the sampling.