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Home My WebLink AboutBUSINESS PLAN~ CLERICO CHIROPRACTIC C ; 600 COFFEE ROAD, #R -- -----s ~ ~ , r 1~ - UNIFLED PROGRAM INSPECTION CHECKLIST ~ Prevention Services >3 A e I: s r , . ,,: 900 Tl-uxtun Ave.; Suite 210 ~...~~_,, .~ ,~ ~ _ ---~~~.,_ ~...~ -_.__.~~.,., . __._~ ~~m__~~ : FIRE - Bakersfield, CA 93301 ~SECT~ON 1:. Business Plan and Inventory Program '°R'M TeL: (661) 326-3979 - - ~ Fax: (661) 872-2171 FACILITY NAME - "- - - C.l e~-~ c~ C,L• pro r ~+c ~-t c. - INSPECTION DATE I j - - D INSPECTION TIME ~ t~-, ~ ADDRESS - -t9c~l:> Cc~FFee ~ Sulk-e R PHONE NO. 1~1- ~3t -y'~v7 O OF EMP YEES c1) FACILITY CONTACT = - ~ cc~ - C~Q ~ BUSINESS ID NUMBER 15-021- 2ggo r- .QVIv~ Section 1: Business Plan and inventory Program ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT _ cg ~~ _ ^ RE-INSPECTION C V (C=Compliance =OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND (~ ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE I~ ^ VISIBLE ADDRESS ~Nfi,~ ® ~ - ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS (~ ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY I~ ^ ` VERIFICATION OF HAZ MAT TRAINING ~ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED I~ ^ \ HOUSEKEEPING " ^ ~ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS~/W~ASTE/ON SI,,TRE? J ,YES ^ NO EXPLAIN: ~I~~IS~f~~u_ ESTIONS REGARDING THIS INSPECTRRION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print Fire Prevention / 1s' In /Shift of Site/Station Business Site / e onsit i - - - White -Prevention Services Yellow -"Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 7. -:l + CLERICO CHIROPRACTIC ________________________________ SiteID: 015-021-002990 + Manager DR KEVIN J CLERICO Location: 600 COFFEE RD R City BAKERSFIELD BusPhone: (661) 831-4407 Map 102 CommHaz Minimal Grid: 33C FacUnits: 1 AOV: CommCode: BFD STA 11 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title DR KEVIN J CLERICO / OWNER / Business Phone: (661) 831-4407x Business Phone: ( ) - x 24-Hour Phone (661) 399-3561x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React ~--- °-Con-tact -: DR"KEVIN=J CLERICO ~~ --~ -~ ~- - '-" Phone: (661) 831-4407x MailAddr: 600 COFFEE RD R State: CA City BAKERSFIELD Zip 93309 Owner DR KEVIN J CLERTCO Phone: (661) 831-4407x Address 600 COFFEE RD R State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN Based on my inquiry of those individuals responsible for obtaining the information, 1 certify under pena of law that I have personally examine and familiar with the information submit d and^M lieve the information is 4rue, 3- Date ~N~`'~ ~ ~' ~ ~dO -1- 03/13/2006 _ __ (HMMP) ~ ~a~~ HAZARDOUS MATERIALS MANAGEMENT PLAN . - - ._ _.. _ .. _._ ..... _ _ ... ~__ _ _...-- .~ .e. ~ 8 8 it 3 H I D . _ . _ a _ .~.~: _ ti PJ1itB SITE & FACILITY DIAGRAM ~~rrur r Page 2 of 2 i BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 SITE DIAGRAM L~ FACILITY DIAGRAM Business Name: _ ' ~`2 (' ~ ~~, ,~ ~,~~~--i ~ ~, Business Address: ~ .~.r~iy~-~S Cad . ~, ~ ~~ ~- (' •i'~ o~ ~~~ ,~~" U ~-~ i ~(~ !!~ ~~~ FD 2170 (Rev. 09/05) NORTH Please indicate direction of North p.+'/i. ' a" ^?a ~ ~. (HMMP) c ~ ~' BAKERSFIELD FIRE DEPT. HAZARDOUS MATERIALS MANAGEMENT PLAN ~ s $ R S F I _ D Prevention Services ~" ~-- _ P/RB 900 Truxtun Ave., Ste. 210 INSTRUCTIONS i `' ~~rre- r Bakersfield, CA 93301 SITE & FACILITY DIAGRAM ~ Tel.: (661) 326-3979 • Fax: (661) 852-2171 Page 1 of 2 These instructions explain the use of the site diagram and the facility diagram. Normally, small and medium size businesses will only have to submit a site. diagram. If you have subdivided your business into smaller areas because of the complexity or size, then you will be completing and additional detail map, facility diagram, for each of these areas. Include instructions that show the route to your business if it is in a remote location. All diagrams must be on 8 '/s x 11" paper and drawn using a straight edge tool. SITE DIAGRAM INSTRUCTIONS The site diagram is used to show your business and to indicate the businesses that immediately surround your property, usually within 300 feet. If you will be showing specific area detail on facility diagrams, use the site diagram to show an overall layout of the plant. If you will not be submitting facility diagrams, the site map must include all of the following information: 1. Check the box on the top left corner of the form provided that indicated "Site Diagram". 2. Print the name of your business, as shown in your I-IlVIl~~IP, on the top of the diagram. 3. Label the location of the hazardous materials and identify them by name and type of hazard (i.e., flammable liquid, corrosive solid). _ 4. Label the location of utility shutoff points for gas, electric and water. services. 5. Label the location of fire hydrants. 6. Label portions of the building protected by automatic sprinkler systems. 7. Label the direction representing north on the diagram. (The diagram form provided includes _ ~a north arrow). . 8. All labeling and identification on the diagram must be legible and easily understandable at the scale submitted. Diagrams must be sufficiently legible to produce a legible copy. Try to avoid the use of abbreviations or symbols. If you must use them, provide a legend explaining your system. Maps may be returned for correction if you fail to follow these instructions. FACILITY DIAGRAM INSTRUCTIONS _ _ Facility diagrams are supplements to the site diagram. Use them to show the subdivision details of a large business. 1. Check the box in the upper right hand corner of the form provided that indicated "Facility Diagram". 2. Print the name of your business as shown on your >-IM1VIP. Print the name of the area that this map represents. This name should be the same name that you used on this area's inventory report. 3. Indicate which area the diagram represents and the total number of facility diagrams that you are including. If a map represented the first of four areas, it would be labeled # 1 of 4. 4. Follow instructions (3 -8)* for site diagrams regarding the specific details to be•included on each facility diagram. UNDERGROUND STORAGE TANK FACILITIES PLEASE NOTE: * If you operate an Underground Storage Tank (IJST) facility, the facility diagram shall also specify the location(s) of the UST continuous leak monitoring system and/or the location(s) where the UST monitoring will be performed. FD 2170 (Rev. 09/05) ~` ;~~ ~ {661}831 A407 ~. ~ . , , ' i ~, ~: ~oFor `. ~,~ DR. KEVtN 1. CLERICO ' " ~ t00 Coffiee Road, Suite R 1 •Date-____,=___--=.~- Bakerstieid, CA 93309 / .: Mme ~ ~ (661) 831-4407 ~' c ~ t~~ ~ i;,,~~,~n =^~. ~,r; . ~~~e 24 hrs. notice. _ ~~Q,~i-Nn1 UNIFIED PROGRAIlA INSPECTION CHECKLIST SECTION 1 Business ,Plan and Inventory Program FACILITY NAME __ _. ADDRESS ------- Cock? . _ .~ ~-~ _ .. ~~_._ . _~.._~- _ . - ~~?J- _ _ . _. FACILITYCONTACT Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93 Tel: (661)_326-3979 _?'?Qpg INSPECTI N DAT INSPECTION TIME -- 4~2~ ~~-- ----------. _ _ _ _ PHONE No No. of Employees Dumber 15- 1- ~) Section 1: Business Plan and Inventory Program ~f'Z~gp ^ Routine Combined ^ Joint Agency OMulti-Agency ^ Complaint ^ Re-In C V nCel OPERATION i l t ( COMMENTS ~-'~~~ o n v=v oa ~~ ^ ^ APPROPRIATE PERMIT ON HAND ~/ ^ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ ^ VISIBLE ADDRESS ^ ^ CORRECT OCCUPANCY ^ ^ ~ VERIFICATION OF INVENTORY MATERIALS I f ~~ ^ ^ VERIFICATION OF QUANTITIES I ~ ~~L ^ ^ VERIFICATION OF LOCATION f Nc)c nL ~nCUC .,Rp,X~^ ^ ^ PROPER SEGREGATION OF MATERIAL ~. r _ ^ ^ VERIFICATION OF MSDS AVAILABILITYE ~ ~~ ~1 ------ ^ -_ ^ --- ----- ------ -----__---- -- - _ . _ ---- ---- __ __ VERIFICATION OF FIAT MAT TRAINING - _ _ _ __ - _ _ _ --- _ _ ---__ _ -. ----- . a-E ^ ^ - VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ---- ---..--- ------------ --._...._._.......--..._..... _~ t _ _ . ._ ._.-- ... ._. _. ~ V ~' .__..__~. .. ._.. __. ...-----------._ __.._......__. ^ ^ EMERGENCY PROCEDURES ADEQUATE ^ ----- ^ - - CONTAINERS PROPERLY LABELED -_ --- -- -- -- ~ ~./~C(S~-~ ~~ZG~I.~!' Jae, /~ ~ t S~ ~/ IJ ^ ^ HOUSEKEEPING ^ ^. FIRE PROTECTION ~ ^ ^ SITE DIAGRAM ADEQUATE Si ON HAND ANY HAZARDOUS WpA/S~T,~E.~O-N~SITE?~"~j~YES ^ IVO EXPLAIN: w~ ~ r L= 'r f ~ ~` QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT ~sG'I~ 3Z6-3979 _ - ------~ ~ ~J ~ _ ___._..__- -- ---- - Inspector (Please Print) Fire P ention 1st-In/Shik of Site While • Environmental Services Yellow -Station Copy m Pink -Business Copy b ._ '- T~i~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES ro y UNIFIED PROGRAM INSPECTION CHECKLIST ~`' ~gti~ 1715 Chester Ave., 3'd FDoor, Bakersfield, CA 93301 FACILITY NAME KG'~1-^l ~ - GC~t co ~ ~G INSPECTION DATE ~'~27 ~~~ Section 4: Hazardous Waste Generator Program EPA ID # ~/ ~' ^ Routine ~ Combined ^ Joint Agency ^Muiti-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number 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 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 50 feet from property line Secondary containment provided ~Ci~~ ~~~ 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 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 ~,=~.ompi~ance v1=vtotauon Inspector: ~ ~ ~ ~~ Office of Environmental Services (661) 326-3979 White -Env. Svcs. Pink -Business Copy Business Site Responsible Party CLERICO CHIROPRACTIC SiteID: 015-021-002994 Manager DR KEVIN J CLERICO Location: 600 COFFEE RD R City BAKERSFIELD BusPhone: (661) 831-4407 Map 102 CommHaz Minimal Grid: 33C FacUnits: 1 AOV: CommCode: BFD STA 11 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title DR KEVIN J CLERICO / OWNER / Business Phone: (661) 831-4407x Business Phone:.( ) - x 24-Hour Phone (661) 399-3561x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x ............... Hazmat Hazards: React ............... Contact DR KEVI N.,J CLERI C__O _ ___ ._ _ Phone: (661) 831-_4407x _ _ _ _ MailAddr:~"600 COFFEE RD R State:~CA City BAKERSFIELD Zip 93309 Owner DR KEVIN J CLERICO Phone: (661) 831-4407x Address 600 COFFEE RD R 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 F E ~ 2 6 ZaQ7 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 submitted and elleve the infiormation is true, accurate, and - plete. ~.-2 Signature date -1- O1/29/~b07 F CLERICO CHIROPRACTIC SiteID: 015-021-00299n ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Sites ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE FIXER R L 5.00 GAL Nrin -2- Ol/29/~007 -3- 01/29/2007 F CLERICO CHIROPRACTIC SiteID: 015-021-00299b ~ ~ 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# Liquid TWaste ~ Ambient~E ~ AmbientT~E ~STICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL t1AGtittLVV~ 1:V1~lYVlV~1V~1~5 ~Wt. RS CAS# --.~_~-» -- Silver ~ -- - --- ------ _ ~ -_ _=~--~----_ ~ - -- -~-- -- - ~ -- No - -_- -744024 t11~GLj.tCL L~~75~J51~liS1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA No No No No/ Curies R / / / Mz -4- O1/29/2b07 F CLERICO CHIROPRACTIC SiteID: 015-021-002990 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification Employee Notif./Evacuation 10/23/2006 EMERGEN,CY_.911.~_ NOTIFICATION. TO_=OWNER,__KEVIN CLERICO; 333-2.061 _OR_ 3.99-3561,_, NON-EMERGENCY SPILLS AS REQUESTED BY FIRE DEPT 326-3979 - CALL SOURCE ONE TECHNOLOGIES. Public Notif./Evacuation 10/23/2006 OWNER TO CONTACT CONTRACTED HAZARDOUS WASTE REMOVAL COMPANY - SOURCE ONE TECHNOLOGIES 559-347-9747. EPA CAR000151332 Emergency Medical Plan 01/05/2006 911 - MERCY ER NON-EMERGENCY - EVACUATE AND REFER, IF NECESSARY. -5- Ol/29/Zb07 F CLERICO CHIROPRACTIC SiteID: 015-021-002996 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 01/05/2066 ~ HAZARDOUS CHEMICALS ARE MAINTAINED IN CLOSED LOOP - USE TO WASTE CONTAINER BACKED UP BY OVERFLOW CONTAINER PRIOR TO FILLING WASTE REMOVAL COMPANY IS CALLED TO REMOVE WASTE AND REPLACE WITH NEW EMPTY OVERFLOW CONTAINER. Release Containment 01/05/20176 T_OTAL__.CONTAINMEN.T._.IN-CLOSED~LOOP AS- DESCRIBED_ _IN=P-REUENTION_MEASURES..~-NO RELEASE DUE TO REDUNDANT OVERFLOW. ` Clean Up 10/23/20176 RUBBER GLOVES WITH GOGGLES TO CLEAN MATERIAL, THEN PLACE WASTE IN PLASTIC SEALED CONTAINER AND TURN OVER TO WASTE REMOVAL SERVICE. V1.11CL tCC.`~'VULC:C liC:l.lVcLI.LUI1 -6- 01/29/2607 F CLERICO CHIROPRACTIC SiteID: 015-021-002990 ~ Fast Format ~ ~ Site Emergency Factors Overall Site, ~N~c:icii nazarus = Utility Shut-Offs 10/23/2006 NATURAL. GAS-: -~_REAR>OF,_BLDG-.=--~- _-~.,-- ~ ---_._._ -_~ - _-_ -, ELECTRICAL: REAR OF BLDG WATER: S END OF BLDG Fire Protec./Avail. Water 12/26/2005 SPRINKLERS AND FIRE EXTINGUISHERS. FIRE HYDRANT - S ENTR TO PROP 600 COFFEE RD NEAR ST. Building Occupancy Level 12/26/2005 1 EMPLOYEE -7- O1/29/Z007 ;• F CLERICO CHIROPRACTIC SiteID: 015-021-002994 ~ Fast Format ~ ~ Training. Overall Sites ~ ~ Employee Training Ol/29/20C~`1 ~ BRIEF SUMMARY OF TRAINING PROGRAM: SAFE HANDLING OF FIXER CHEMICAL DONE BY' LICENSED EPA/HAZARDOUS WASTE REMOVAL COMPANY: SOURCE ONE TECHNOLOGIES; RUBBER GLOVES/GOGGLES TO BE WORN WHEN IN CONTACT AT ANY TIME WITH FIXER CHEMICAL; USE OF 911 - PRIVATE HAZMAT REMOVAL SERVICE AND FIRE SPRINKLER AND EXTINGUISHER AVAILABLE - PROPER OVERFLOW CONTAINMENT CONTAINERS USED TO PREVENT ANY SPILLS; EMERGENCY EXITS ARE MARKED AND ILLUMINATED DOOR WITH LOCK; AND 911 CONTACT FIRE AS INDICATED ABOVE. Page 2 Held for Future Use neiu ic~i r u~ure use -8- 01/29/2007