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Home My WebLink AboutBUSINESS PLAN 7/19/2007 r jAJITPALTS~.EE ANA, a, < ,2700 F S _- - -- M.D. STATE OF CALIFORNIA -FORESTRY AND FIRE PROTECTION FIRE SAFETY INSPECTION REQUEST STD. 850 (REV. 4-2000) See instructions on reverse. AGENCY CONTACT'S NAME - TELEPHONE NUMBER REQUEST DATE PROGRAM Cheryl Fuller; AGPA '(661) 336-0543 10!23!2007 Licensing and Certification EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 'Karen Grounds, HFES Facility LD. 630001481 IA CODES ~ 1. ORIGINAL A. FIRE CLEARANCE LICENSING I (',alifornia Department of Public Health 2. RENEWAL B. LIFE SAFETY AGENCY Licensing and Certification NAME AND 1200 Discgvcry Plaza, SllILe 120 3. CAPACITY CHANGE ADDRESS Bakersfield, CA 93309 4. OWNERSHIP CHANGE 5. ADDRESS CHANGE 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY ~ PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY FACILITY NAME LICENSE CATEGORY Healing Arts Surgery Center Stugical Clinic STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS 2700 F Street, Suite 100 1 -CITY RESTRAINT Bakersfield, CA 93301 . FACILITY CONTACT PERSON'S NAME FAGLITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Ajitpal S. Tiwana; ivi.D. (661) 325-5513 or 322-4325 < 24 Sf'tGIAL GVNUI I IVNS Fire clearance requested for alteration/construction of s>,ugical center. TO BE COMPLETED BY INSPECTING AUTHORITY CLEARANCE /DENIAL CODE GiTY OF 9~K~ ~ ' R FPELD FiAE 1~~ ~~,~Tl1t3EN~ ~ PREVE~3Ti CODES FIRE AUTHORITY NAME AND ADDRESS ON SERVICES FIRE SAFETY SERVICES ENVIRONMENTAL SERVICES 1600 TRUXTUI~ AVF.Nl:1F=. SUITS .401 d~rx~i`t~r1;=Ld7, C,~ILI~C7f~-,.NIA ~,3~01 ~" - -- ~1. FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM INSPECTOR'S NAME (Typed orPnnted) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD INSPEC ION D E t l i~ 7 INSPECTOR'S ATU E (Typed orPnnted) ~, ..~~..,.,.,.,~- G. OTHER EXPLAIN DE IAL OR LIST SPECIAL CONDITIONS TIWANA MD AJITPAL S Manager ~"`~h Location: 2700 F ST City BAKERSFIELD CommCode: BFD STA Ol EPA Numb: ~c y irs SiteID: 015-021-002260 BusPhone: (661) 325-5513 lylap 102 CommHaz Minimal Grid: 24D FacUnits: 1 AOV: SIC Code:8011 DunnBrad: Emergency Contact / Title ~` '~~ ¢ Emergency Contact / Title R9S / MANAGER ~'~ / Business Phone: (661) 325-5513x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact ~1~,'~~1 ~C`(C-s+ Phone: (661) 325-5513x MailAddr: 2700 F ST State: CA City BAKERSFIELD Zip 93301 Owner AJITPAL S TIWANA MD Phone: (661) 325-5513x, _ Address. :- 2700 -F S-T- ~ - ---- ~ -- - - -- -- - _ - -~'" '- State :---CA -' - ---- -" City BAKERSFIELD Zip 93301 Period to TotalASTs: _ Gal Preparers TotalUSTs: = Gal Certif' d: RSs : No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN E'Y~ ! ~ ` v ~ ®~ uais ~`a~'Rd on my inquiry of those indi respon~il.~"e far ohiair~ing the information, I Certify uncser Nenalty ai iaU! that i have personaily GXamined ~;nd am familiar with the inform ti a on sus~niitted and heiieve the information is true, accurate, and complete. ~wa~, ~ I 14I~- , . . Signature Date ' ~~ ~p>a~~~G -1- 07/16/2007 F TIWANA MD AJITPAL S ~ Hazmat Inventory = ~ MCP+DailyMax Order = SiteID: 015-021-002260 ~ By Facility Unit ~ Fixed Containers at Site ~ Hazmat .Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE FIXER R L 5.00 GAL Min -2- 07/16/2007 -3- 07/16/2007 S \ i F TIWANA MD AJITPAL S ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME WASTE FIXER Location within this Facility Unit DARKROOM SiteID: 015-021-002260 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# Liquid TWaste ~ AmbRent~E ~ AmbientT~E ~ PLASTOICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 5.00 GAL 5.00 GAL 5.00 GAL rlta~.ytcl~~ua ~vlnrv1V1;1V 1-5 %Wt. RS CAS# Silver No 7440224 ri1-~GEihCL H75~5~1~1~1V l TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 07/16/2007 F TIWANA MD AJITPAL S SiteID: 015-021-002260 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 04/12/2007 i PHONE LIST. 911. Employee Notif./Evacuation 04/12/2007 VERBAL NOTIFICATION. EXIT THROUGH FRONT DOORS OR ANY OF THREE EMERGENCY EXIT DOORS. Public Notif./Evacuation 04/12/2007 VERBAL NOTIFICATION. EXIT THROUGH FRONT DOORS OR ANY OF THREE EMERGENCY EXIT DOORS. Emergency Medical Plan DOCTOR ON STAFF. TRANSPORT TO HOSPITAL BY AMBULANCE. 04/12/2007 -5- 07/16/2007 F TIWANA MD AJITPAL S SiteID: 015-021-002260 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention - Release Containment Clean Up 04/12/2007 USE MOP AND SPILL KIT FOR SMALL SPILLS. CALL 911 FOR LARGE SPILLS. Other Resource Activation -6- 07/16/2007 -0' F TIWANA NID AJITPAL S SiteID: 015-021-002260 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ J~JCC:1d1 IldGdl US Utility Shut-Offs GAS: E SIDE OF BLDG ELECTRICAL: N SIDE CLOSET WATER: E SIDE OF BLDG 04/12/2007 Fire Protec./Avail. Water 04/12/2007 FIRE EXTINGUISHERS FIRE HYDRANT FRONT OF OFFICE D1111U111y VC: C:U~Jd11C:~/ LCVC1 -7- 07/16/2007 ? Y F TIWANA MD AJITPAL S SiteID: 015-021-002260 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 04/12/2007 ~ BRIEF SUMMARY OF TRAINING PROGRAM: OSHA TRAINING Page 2 Held for Future Use Held for Future Use -8- 07/16/2007 Ajitpal S Tiwana M.D. 2700 F St Bakersfield, Ca 93301 661-325-5513 August 9, 2006 Re: Ajitpal S. Tiwana M.D. Fire Department Permit to Operate Permit ID# 015-021-002260 This letter is in regards to the address on the permit we have now with our old address 2635 G St. The address has changed to 2700 F St. we recently moved to this location beginning 8/1/06. I was advised to send you a letter with a date of when we would be in the new building so I am doing that in order for us to get our new permit. Please feel free to call the office with any questions that you may have regarding this matter. Thank you, -- - r _4__- _ __ _._ _ _ _ _ - _ - = - --. Sincerely, A~~-~ea~ ~ . i ~ v~~ A-na M_ ~. ~ . .:.. ~\ :, _ ~ -s, TIWANA MD AJITPAL S p ~ Manager ~dS~4hd~ • ~~ ~~1~ Location: 2700 F ST City BAKERSFIELD CommCode: BFD STA Ol EPA Numb: SiteID: 015-021-002260 BusPhone: (661) 325-5513 Map 10.2 CommHaz Minimal- -~ -- Grid: 24D FacUnits: 1 P,OV: ____ - ~ - ~ ~ SIC Code:8011 DunnBrad: Emergency Co tact / Title Si4Nd~~'R~~~h~~ ~ l~~'lw'~CxEt. Emergency Contact / Title / Business Phone: (661) 325-5513x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone : ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React .Contact-: ~ ~ph~~'~~ Phone: (661) 325-5513x MailAddr: 2700 F ST State: CA City BAKERSFIELD _ _ _ Zip :.. .93301 _,~.--, Owner AJITPAL S TIWANA MD Phone: (661) 325-5513x Address 2700 F ST State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H -~HAZ WASTE GEN ENT'D MAR 1 2007 S?sed on responit~le fmy .~,~ gr~rrY of those under o~ aining the inf rduals ~r ' ormatio E exa penalty of law that I have certify mined and am fa pers s onally miliar with the uQmitted and believe the inform rnformation accurate and , ation is complete. true, Signature ( .-( W 0~ ~- o~$ I 0 Dat e -1- 02/16/2007 s F TIWANA MD AJITPAL S SiteID: 015-021-002260 ~ ~ 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- 02/16/20.07 f -3- 02/16/2007 c F TIWANA MD AJITPAL S ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME WASTE FIXER Location within this Facility Unit DARKROOM ~- ~ -- STATE Liquid SiteID: 015-021-002260 ~ Facility Unit: Fixed Containers at Site ~ Days On .Site 365 Map: Grid: - CAS# TEMPERATURE ~~ CONTAINER TYPE Ambient I PLASTIC CONTAINER TYPE PRESSURE Waste ~mbient AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 5.00 GAL 5.00 GAL 5.00 GAL t1E~GHKLVUS 1:V1~lYV1Vt;1V 1'~ %Wt. RS CAS# Silver No 7440224 riAGAlCL AS~J;~S1~1~1V"1"5 _ ~ _ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 02/16/2007 F TIWANA MD AJITPAL S SiteID: 015-021-002260 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification r~~- = Employee Notif./Evacuation ,~ ~- rU1J111. 1VV 1.11. ~ IjV0.1. t10.V1V11 P~lllC 11~. Clltry 1'1C1111.0.1 2'16111 -5- 02/16/2007 ;. F TIWANA MD AJITPAL S SiteID: 015-021-002260 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention - KeledSe l=Ui1Cc1111[R~ill, 1.1.CC111 1J~1 va.iici i~cov ui~..c rig. ~.i va~.1 V11 -6- 02/16/2007 F TIWANA MD AJITPAL S SiteID: 015-021-002260 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .7YCC:1d1 rid'Gd1.U~ Utility Shut-Offs ,.. ri1.c r.LV~c~:.~riydil. YYdI.Cl D l.L 1:11A 111y Vl: Ir U~J dlll.:y LCVC1' -7- 02/16/2007 ti F TIWANA MD AJITPAL S SiteID: 015-021-002260 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training Page 2 Held for Future Use nciu ivi r u~.utc vac -8- 02/16/2007 . c~~~1~ E - _- ; r Prevention Services UNI~iE"~ PROGRAM INSPECTION CHECKLIST ' a „ ~ F R s ,: , 0 900 Trtixtun Ave., Suite 210 `~ F~Re v;. Bakersfield, CA 93301 SECTION 1: business Plan and Inventory Program ° ~~ T Tel.: (661) 326-3979 y Fax: (661-) 872-2171 FACILITY NAME ~ ~~ ~^~~ ~ ~,J INSPECTI; ZDA~ INSPECTION TIME ' w ~~ ~ M \ ` ~. ' ADDRESS " PHONE NO. NO OF EM P LOYEES ~~++~~ 27OV 1t' j ~ ~~i~-~.S !~ y ~ ~ V FACILITY CONTACT ~ BUSINESS ID NUMBER 15-021-m~s~ozt~eo Section 1: Business Plan and Inventory Program ^ ROUTINECOMBINED ^ 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 v ~ ~ ~ ,~ ^ VERIFICATION OF MSDS AVAILABILITY '~ ^ VERIFICATION OF HAZ MAT TRAINING yI ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ~Q ^ HOUSEKEEPING ^ FIRE PROTECTION ~',.,~',.,,5,,~,Si~4,~ ~~ )7 S~ h Na_ccRs ~vp~,t ~ ^ $ITE DIAGRAM ADEQUATE & ON HAND ~ ~i1~-~. b+h r n + c~ O+~' ~ ~ { ANY HAZARDOUS WASTE ON SITE? ~~YES ^ NO EXPLAIN: ~~"~~~ ~~"'C "- 2(,0 QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~ ~~,~~ ~~ Inspector (Please Print) Fire Prevention / 1~' In /Shift of Site/Station # ( ~- CJ " Business Site /Respond a Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 _T~1 CITY OF BAKERSFIELD FIRE DEPARTMENT ~~ OFFICE OF ENVIRONMENTAL SERVICES b~ y UNIFIED PROGRAM INSPECTION CHECKLIST ~r•E`~gti,/~ 1715 Chester Ave., 3~d Floor, Bakersfield, CA 93301 FACILITY NAME ~ 1 ~ A ~ ~ ~ Sectiion 4: Hazardous Waste Generator Program INSPECTION DATE ~ Il Z'l a7 EPA ID # ~ ~r~~P r- ^ Routine ~] Combined ^ Joint Agency ^Muiti-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number ~',r ~,,,, p ~- Authorized for waste treatment and/or storage Reported i°elease, 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 V Containers are kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line ~ ,,/~, Secondary containment provided p- ~e ~, ~ Se e,0~~ ~ ' ~r~d, 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 hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years Retains hazardous waste analysis for 3 years _ Retains copies of used oil receipts for 3 years ~ ~ Determines if waste is restricted from land disposal =~ompnance vv=v~otanon Inspector: ~ I ~~-Z ` `` Office of Environmental Services (661) 326-3979 White -Env. Svcs. Pink -Business Copy ~ ~ y G(~ ~/ usiness Site Responsible Party -;. t 2-~~'1 D ~~~~~/~~ Prevention Services UN1~ED PROGRAM INSPECTION CHECKLIST ~~ R ~/~ F R s e , . „ 900 Truxtun Ave., Suite 210 SECTION 1:~_TB_~__~~.~..,~_~.~___ -__m_mm m_--_~~__- F~RF Bakersfield, CA 93301 m usin@SS Plan and Inventory Program °~ aRrM T Tel.: (661) 326-3979 Fax: (661) a72-2171 FACILITY NAME ~ _ _ ~ INSPECjION DATE INSPECTION TIME ADDRESS n . i . PHONE NO. NO OF EMPLOYEES Z~®p r z -~~31 FACILITY CONTACT - BUSINESS ID NUMBER 15-021-1315.OZl^oo Section 1: Business Plan and Inventory Program '° ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ( C=Compliance OPERATION V=Violation COMMENTS '~(~I ^ APPROPRIATE PERMIT ON HAND ~f7 ^ BUSIrI@SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS 6a.1 v 1 et.~ ~ ~ ~ ~ Q ~(~ Q'] 4.'V) ~j ~,J / ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ ~ VERIFICATION OF MSDS AVAILABILITY ~, ~~~ ~ MS~~']S e'° a)' ~..nJ G c..ls ^ ~~7 VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ F'IOUSEKEEPING ~ i~ ~.i ~~ ~t ~~ ~Uko [ ~ ~- ~1~u -~ ^ ~ FIRE PROTECTION ~'~ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARD``O^~U~S WASTE ON SITE?BYES ^ NO EXPLAIN: ll.J ~^ C ~ ~ `'C ~ X ~ z-33 v ~ 4~ py i . QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1s~ In /Shift of Site/Station # Business Site R spons le Pa lease Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy ~ FD 2155 (Rev. 09/05 ~-~ 1 ~ ~ ~0~~~~ ~o ~ `~ CITY OF BAKERSFIEIJD FIRE DEPARTMENT ~~ b OFFICE OF ENVIRONMENTAL, SERVICES ~' .y UNIFIED PROGRAM INSPECTION CHECKLIST •,W~;'' Agti,~'~ 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~A~ i C K. M~ INSPECTION DATE ~ ~ 1 Z' ~ ~ z Section 4: Hazardous Waste Generator Program EPA ID # 7~ ~ ~^- n t• ^ Routine ~ Combined ^ Joint Agency ^Muiti-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number Cj~ t;••- ~-~" 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 Containers in good condition and not leaking Containers aze compatible with the hazardous waste Containers aze kept closed when not in use Weekly inspection of storage azea Ignitable/reactive waste located at least 50 feet from property line /'J ~ Secondazy containment provided Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste /~ ~ Proper management of lead acid batteries including labels N l~ Proper management of used oil filters 1J ~, Transports hazazdous waste with completed manifest Sends manifest copies to DTSC ~ ,~„ ~, i G ~ ~ Retains manifests for 3 years Retains hazazdous waste analysis for 3 years Retains copies of used oil receipts for 3 years /1j ~ Determines if waste is restricted from land disposal ~°~ompt~ance v=v~otat~on Inspector: (i ~G~IL~. ~--> Office of Environmental Services (661) 326-3979 White -Env. Svcs. Pink -Business Copy 1, Business Site Responsible Party