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HomeMy WebLinkAboutBUSINESS PLAN 7/19/2007t - ~- ~' LARRY A VALERO, DDS ~~ ' 207 H STREET ~ -- - - - - S 1 fi SULTZE CHIROPRACTIC SiteID: 015-021-002093 Manager GALE G MITCHELL Location: 345 H ST City BAKERSFIELD BusPhone: (661) 327-2588 Map 103 CommHaz Minimal Grid: 31C FacUnits: 1 AOV: CommCode: BFD STA 06 EPA Numb: SIC Code:4941 DunnBrad:77-025-4824 Emergency Contact / Title Emergency Contact / Title STUART A SULTZE DC / OWNER JON R MORRIS DC / EMPLOYEE Business Phone: (661) 327-2588x Business Phone: (661) 327-2588x 24-Hour Phone (661) 664-1982x 24-Hour Phone (661) 872-4575x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: RSs Fire Press ImmHlth Contact GALE G MITCHELL Phone: (661) 327-2588x MailAddr: 345 H ST State: CA City BAKERSFIELD Zip 93304 Owner STUART A SULTZE DC Phone: (661) 327-2588x Address 345 H ST State: CA City BAKERSFIELD Zip 93304 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: Yes ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ENT ~uL 2 3 zoos „w n on my inquiry of those individuals thn informaticn, I cer.a,y ~•F s~v~G~~~h'~e Scar cxataa~~inq nattY cf ia~~ ersonally that t have p t cr under ~e ox2t'nlnA'~ a,id a ~, fia gi S r ~e, is lthe info mation s~shrnit+.ed rt'''t lete. ~ orn c accurate, anc~ , ~ ~l f~~,~ \~~" t /,~, e _I ' _ "~"- at D •ignat~are -1- 07/16/2007 F SULTZE CHIROPRACTIC SiteID: 015-021-002093 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... ISpecHazlEPA Hazards) Frm I DailyMax IUnitIMCP~ WASTE FIXER F P IH L 5.00 GAL Minl -2- 07/16/2007 '~ -3- 07/16/2007 1. F SULTZE CHIROPRACTIC SiteID: 015-021-002093 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: INSIDE BLDG CAS# STATE Liquid TYPE Waste = PRESSURE Ambient TEMPERATURE CONTAINER TYPE Ambient '~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 5.00 GAL 5.00 GAL 5.00 GAL nt~~t~tcl~vu~ ~ulnrviv~ivt5 %Wt. RS CAS# Silver No 7440224 riHGE1tC1l A55JJ551~1J;1V'1'~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No Yes No No/ Curies F P IH / / / Min -4- 07/16/2007 F SULTZE CHIROPRACTIC SiteID: 015-021-002093 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 06/02/2006 ~ X-RAY REGULAR INSPECTIONS BY MXR MERRY X-RAY/SOURCEONE HEALTHCARE 559-292-9729. _-- Employee Notif./Evacuation 04/06/2007 VERBAL/TELEPHONE/EVACUATE FRONT OR BACK DOOR Public Notif./Evacuation 04/06/2007 VERBAL/EVACUATION OUT FRONT OR BACK DOOR Emergency Medical Plan 12/13/2000 EMPLOYEES TRAINED IN CPR AND CALL 911. -5- 07/16/2007 .y F SULTZE CHIROPRACTIC SiteID: 015-021-002093 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 06/02/2006 ~ MXR MERRY X-RAY/SOURCEONE HEALTHCARE Release Containment 06/02/2006 MXR MERRY X-RAY/SOURCEONE HEALTHCARE Clean Up MXR MERRY X-RAY/SOURCEONE HEALTHCARE 06/02/2006 vl.tict ACe7VUil:C 1'il:l.lVdl.1V11 -6- 07/16/2007 i F SULTZE CHIROPRACTIC SiteID: 015-021-002093 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ J~JC l.:1d1 I1dGdI. U.~" Utility Shut-Offs 04/06/2007 GAS - OUTSIDE OFFICE ELECTRICAL - UTIL RM IN OFFICE WATER - OUTSIDE OFFICE Fire Protec./Avail. Water 01/23/2007 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. FIRE HYDRANT - WITHIN 60FT OF BLDG. Building Occupancy Level 05/09/2006 4 EMPLOYEES -7- 07/16/2007 F SULTZE CHIROPRACTIC SiteID: 015-021-002093 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/09/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: STAFF MEETINGS/HANDBOOK. rayc ~ nciu ivi ru~uic u~c nciu iui r u~u.GC u~c -8- 07/16/2007 r.. 1 ~ , VALERO DDS LARRY A SiteID: 015-021-002354 Manager LACY BECK BusPhone: (661) 323-7440 Location: 207 H ST Map 103 CommHaz Minimal City BAKERSFIELD Grid: 31C FacUnits: 1 AOV: CommCode: BFD STA 06 SIC Code:8021 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title LARRY A VALERO DDS / OWNER ESMERALDA FLORES / OFFICE MANAGER Business Phone: (661) 323-7440x Business Phone: (661) 323-7440x 24-Hour Phone (661) 323-7440x 24-Hour Phone (661) 663-9321x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact LARRY A VALERO DDS Phone: (661) 323-7440x MailAddr: 207 H ST State: CA City BAKERSFIELD Zip 93304 Owner LARRY A VALERO DDS Phone: (661) 323-7440x Address 207 H ST State: CA City BAKERSFIELD Zip 93304 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN // II4f./cN t~la~ ( ~ j~S /mob G ~ ~~re5c' on my inquiry of these indivi~~iaa!s re~r.;Cr+G~,ii`~!e far obtaining the information, I c~;rtify unvcr penalty cf law that I have personally ~xl mir,nd and am farniliar with the information sut~miitEd and br:lieve the information is true, accurate, and complete. ~~~%u SAS 7 - /~'_ 07 Signature Oate ENT'D ~ ~- ~ 3 2007 -1- 07/16/2007 m F VALERO DDS LARRY A SiteID: 015-021-002354 ~ ~ 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 30.00 GAL Min -2- 07/16/2007 ~. -3- 07/16/2007 ~ ~. ` ~ F VALERO DDS LARRY A ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME WASTE FIXER Location within this Facility Unit DARKROOM STATE TYPE PRESSURE Liquid TWaste -~mbient SiteID: 015-021-002354 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# TEMPERATURE ~ CONTAINER TYPE Ambient I PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 30.00 GAL 30.00 GAL 30.00 GAL HAZARDOUS COMPONENTS oWt. RS CAS# Silver No 7440224 L1h~GHtCL 1j. 7.7L" b51~1~1V-1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 07/16/2007 :~ F VALERO DDS LARRY A SiteID: 015-021-002354 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 05/23/2006 ~ EMPLOYEE NOTIFICATION THROUGH EMPLOYER. AGENCY NOTIFICATION THROUGH MONITORING PROCEDURES. Employee Notif./Evacuation 05/23/2006 EMPLOYEE NOTIFICATION THROUGH EMPLOYER. AGENCY NOTIFICATION THROUGH MONITORING PROCEDURES. Public Notif./Evacuation 04/06/2007 VERBAL NOTIFICATION/EVACUATION THROUGH FRONT AND REAR DOOR Emergency Medical Plan 05/23/2006 EYES - FLUSH IMMEDIATELY AT EYE STATION IN ROOM 1. SKIN - FLUSH IMMEDIATELY FOR APPROXIMATELY 15 MINS OR MORE WHILE REMOVING ANY CONTAMINATED CLOTHING. -5- 07/16/2007 F VALERO DDS LARRY A SiteID: 015-021-002354 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 06/01/2006 ~ PROTECTION GLOVES AND MASK. WORKING SOLUTION - WASH WITH SOAP AND WATER. Release Containment 06/01/2006 PROTECTION GLOVES AND MASK WORN DURING MONTHLY CLEANING AND TRANSPORTING OF SOLUTION UPON PREPARATION OF DISPOSAL PICK UP. Clean Up PROTECTIVE GLOVES AND MASK WORN. CALL 911. 05/23/2006 V1.11C1 ttCSCJUlC:~ 1~CL1Va.L1oi1 -6- 07/16/2007. F VALERO DDS LARRY A SiteID: 015-021-002354 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ oNc~;ial na~aiua Utility Shut-Offs 04/06/2007 GAS: S SIDE OF BLDG ELECTRICAL: W SIDE OF BLDG WATER: S SIDE OF BLDG Fire Protec./Avail. Water 06/01/2006 2 EXTINGUISHERS: 1 FRONT OFFICE AND 1 REAR OFFICE FIRE HYDRANT: 1 BLOCK S 1 BLOCK N Building Occupancy Level 05/23/2006 3 EMPLOYEES -7- 07/16/2007 -, 4 F VALERO DDS LARRY A SiteID: 015-021-002354 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/23/2006 ~ MSDS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: REVIEW LOCATION OF WASTE AND THE EYE WASH STATION. INDICATE THE IMPORTANCE OF FOLLOWING THE GUIDELINES LISTED IN THE MSDS. STRESS THE MEDICAL NECESSITY OF THE CLEAN-UP PROCEDURES, AND THE NEED TO CALL 911 IF SITUATION OR SPILL OCCURS. rayC ~ nciu ivi ru~uiC u5C Held for Future Use -s- 0~/16/200~ + VALERO DDS LARRY A __________________________________ SiteID: 015-021-002354 + Manager BusPhone: (661) 323-7440 Location: 207 H ST Map 103 CommHaz Minimal City BAKERSFIELD Grid: 31C FaCUnits: 1 AOV: CommCode: BFD STA 06 SIC Code:8021 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title LARRY A VALERO DDS / LACY BECK / OFFICE MANAGER Business Phone: (661) 323-7440x Business Phone: (661) 323-7440x 24-Hour Phone (661) 323-7440x 24-Hour Phone (661) 398-8665x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact LARRY A VALERO DDS Phone: (661) 323-7440x MailAddr: 207 H ST State: CA City BAKERSFIELD Zip 93304 Owner LARRY A VALERO DDS Phone: (661) 323-7440x Address 207 H ST State: CA City BAKERSFIELD Zip 93304 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: ~ Emergency Directives: ~ PROG H - HAZ WASTE GEN n_ _ O~ i/ ---- V\~ i~ 0~ ~. 'CT' ~~ EN~''p Ju Sased on my tnq-airy of those individuals ~V o 1 2006 responsible for obtaining tha Information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and baiieve the Information is true, accurate, and complete. Signature Date -1- 05/23/2006 a, 1 F VALERO DDS LARRY A Manager LACY BECK Location: 207 H ST City BAKERSFIELD CommCode: BFD STA 06 EPA Numb: ti~n~3 SiteID: 015-021-002354 BusPhone: (661) 323-7440 Map 103 CommHaz Minimal Grid: 31C FacUnits: 1 AOV: SIC Code:8021 DunnBrad: Emergency Contact / Title _-. Emergency Contact / Title LARRY A VALERO DDS / ;~ Ow N c /' ~ ~i-~;C~~~i~~S~~ ~ ~S f OFFICE MANAGER Business Phone: (661) 323-7440x ~ Business Phone: (661) 323-7440x 24-Hour Phone (661) 323-7440x 24-Hour Phone (661) ~-8$fstssx~~°9 Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact LARRY A VALERO DDS Phone: (661) 323-7440x MailAddr: 207 H ST State: CA City BAKERSFIELD Zip 93304 Owner LARRY A VALERO DDS Phone: (661) 323-7440x Address 207 H ST State: CA City BAKERSFIELD Zip 93304 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN O` ENT'D MAY 21 2007 G2=sr d on my inquiry of those individuals respansih-e for obtaining the information, !certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true , accurate, and complete. ~ ~ ~~P 5-~7-~7 _ _ S gnature s Date -1- 02/20/2007 F VALERO DDS LARRY A SiteID: 015-021-002354 ~ ~ 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 30.00 GAL Min -2- 02/20/2007 -3- 02/20/2007 F VALERO DDS LARRY A SiteID: 015-021-002354 ~ ~ 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# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Waste -~mbient ~ Ambient ~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 30.00 GAL 30.00 GAL 30.00 GAL rlr~~t~rcl~~u5 ~:~l~ir~lvrlv'1'S %Wt. RS CAS# Silver No 7440224 riHGEiK11 A55t5551~1L"~1V'1'~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 02/20/2007 F VALERO DDS LARRY A SiteID: 015-021-002354 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 05/23/2006 ~ EMPLOYEE NOTIFICATION THROUGH EMPLOYER. AGENCY NOTIFICATION THROUGH MONITORING PROCEDURES. Employee Notif./Evacuation 05/23/2006 EMPLOYEE NOTIFICATION THROUGH EMPLOYER. AGENCY NOTIFICATION THROUGH MONITORING PROCEDURES. ,_, ,~ rUiJll~. ivV l.11~.G VCL (-: UGL I.l Vll Emergency Medical Plan 05/23/2006 EYES - FLUSH IMMEDIATELY AT EYE STATION IN ROOM 1. SKIN - FLUSH IMMEDIATELY FOR APPROXIMATELY 15 MINS OR MORE WHILE REMOVING ANY CONTAMINATED CLOTHING. -5- 02/20/2007 1 . F VALERO DDS LARRY A SiteID: 015-021-002354 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 06/01/2006 ~ PROTECTION GLOVES AND MASK. WORKING SOLUTION - WASH WITH SOAP AND WATER. Release Containment 06/01/2006 PROTECTION GLOVES AND MASK WORN DURING MONTHLY CLEANING AND TRANSPORTING OF SOLUTION UPON PREPARATION OF DISPOSAL PICK UP. Clean Up 05/23/2006 PROTECTIVE GLOVES AND MASK WORN. CALL 911. V1.11C 1. 1CC~V U1_l.:C lil: l.lVdl.1 V11 -6- 02/20/2007 .> ., ~ __. F VALERO DDS LARRY A SiteID: 015-021-002354 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ a~/c~lai na.~ctiu5 Utility Shut-Offs = Fire Protec./Avail. Water 06/01/2006 2 EXTINGUISHERS: 1 FRONT OFFICE AND 1 REAR OFFICE FIRE HYDRANT: 1 BLOCK S 1 BLOCK N Building Occupancy Level 05/23/2006 3 EMPLOYEES -7- 02/20/2007 d , -e ~r ' .~ n _ ,~. F VALERO DDS LARRY A SiteID: 015-021-002354 ~ Fast Format ~ ~ Training Overall Site ~~, ~ Employee Training 05/23/2006 ~ ', MSDS ON FILE. BRIEF SUNIMARY OF TRAINING PROGRAM: REVIEW LOCATION OF WASTE AND THE EYE WASH STATION. INDICATE THE IMPORTANCE OF FOLLOWING THE GUIDELINES LISTED IN THE MSDS. STRESS THE MEDICAL NECESSITY OF THE CLEAN-UP PROCEDURES, AND THE NEED TO CALL 911 IF SITUATION OR SPILL OCCURS. rayc a azclu ivi r ul..ulc UDC nclu tvi r ul.ulC UDC -8- 02/20/2007 ~•S. ~ V --" ~~ Prevention Services U ` PIED PROGRAM INSPECTION CHECKLIST. ~' R .~~F R s F , ;,. „ 900 Truxtun Ave., Suite 210 ~.~~ .._ ~K Fa'RE ) Bakersfield, CA 93301 ARAM r Tel.: (661) 326-3979 SECTION 1: Business Plan and Inventory Program ~ Fax: (661) 872-2171 FACILITY NAME ~a1 5 ~ INSPEC/TION ATE .f5 ~a~ INSPECTION TIME ~Q,rO ~. ADDRESS ~• - ~~ sk 2 ~ PHONE NO. d 7`t NO OF EMPLOYEES 7 ~-~ -~ Y ~ FACILITY CONTACT BUST SS ID NUMBER 15-021- 01S ,OZ1~O0 Section 1: Business Plan and Inventory. Program -- _ _ _ _ -- ^ ROUTINE L7 COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIIIeSS 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 Sea t ~ ~ ts. t. / ~ ,. +^~ V. ! ~-/' 1 ^ SITE DIAGRAM ADEQUATE & ON HAND ~~~ ANY HAZARD`O;U~S WASTE ON SITj~? `~~1 YES ^ N~ EXPLAIN: w ~~` S~p` ~/ 1 ~~~ i QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~v~ ~k, z-,--~ Inspector (Please Print) Fire Prevention / 1s~ In /Shift of Site/Station # ~~ ~~ White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 .: ~, .~'~ " ,!-" ~P45`~ ~~~~~ CITY OF BAKERSFIELD FIRE IDEPARTMENT ~~ ~ OFFICE OF ENVIRONMENTAL SERVICES ~' •y UNIFIED PROGRAM INSPECTION CHECKLIST % P ~~~ 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~ °~ ~ ~'• © ~5 INSPECTION DATE ~ ~ S' ~; Section 4: Ilaaardous Waste Generator Program EPA ID # `I X ~ J't^ P T ^ Routine -~ Combined ^ Joint Agency ^hulti-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number ~C C ts, P "(' 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 ~~--~ /V_~,,,,~ ~,.~ L ~, Containers in good condition and not leaking Containers are compatible with the hazardous waste - a Containers are kept closed when not in use Weekly inspection of storage area Ignitablelreactive waste located at least 50 feet from property line Secondary containment provided Conducts daily inspection of tanks Used oii not contaminated with other hazardous waste ~ ~ Proper management of lead acid batteries including labels N~,( Proper management of used oil filters n1 /~4 Transports hazardous waste with completed manifest ~ ~,` S ~ ~ ~- w ~-w~ 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 ~=~ompitance v=vtotauon Inspector: ~'~G-~-~~ ~--~ Office of Environmental Services (661) 326-39?9 White -Env. Svcs. Pink -Business Copy v ~~~~ Business Site Responsible Party