HomeMy WebLinkAboutBUSINESS PLAN (2)CROSSTOWN FAMILY DENTISTRY)
2415 G STREET
+ CROSSTOWN FAMILY DENTISTRY ___________ _______________ SitelD: 015-021-002282 +
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.Manager NOLtY ~(7tJt~t~L1"'r
BusPhone: (661) 323-2527
Location: 2415 G ST Map 102 CommHaz Minimal
City BAKERSFIELD Grid: 25B FacUnits: 1 AOV:
CommCode: BFD STA O1 SIC Code:8021
EPA Numb: DunnBrad:
Emergency Contact / Title Emergency Contact / Title
Na~Y ~o~n~~. Nom- / oral c~ i~1FhJA(7>::2. L~~ V~n~.tEZ / iZ~c~tottr~t i~/kuA-t;>=2
Business Phone: (ls+lal, )3~~ -~~2'lx Business Phone: (~lel )3t1 -551"3 x
2 4 -Hour Phone ( islet )~y~ -`t 11.~~ x 2 4 -Hour Phone (~ln~i ) `~ ((v - ~i'{5 ~ x
Pager Phone ( ) - x Pager Phone ( ) - x
Hazmat Hazards: _~ React
Contact Phone: (661) 323-2527x
MailAddr: 2415 G ST ~ State: CA
City BAKERSFIELD Zip 93301
Owner INTERDENT INC Phone: (661) 323-2527x
Address 222 N SEPULVEDA BLVD 740 State: CA
City EL SEGUNDO ~ Zip 90245
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
Emergency Directives: ~
PROG H - HAZ WASTE GEN ~~~
~j~' ENT'0 ,1 U L, 14 2006
c ~
~~ ~
Based on my inquiry of those individuals ~~
responsible for obtaining the information, I certify S
under penalty of law that I have personally
examined and am familiar with the information
submfttad and believe the information is true,
acc rate, and complete.
~ ~~
Signature - D to
-1- 05/15/2006
T=- ~,
UN~fI~D PROGRAM INSPECTION CHECKLIST
SECTION 1. Business Plan and Inventory Program
Prevention Services
R A- F R s r, n 900 Truxtun Ave., Suite 210
Fi1aE " Bakersfield, CA 93301
v aRrIN Tel.: (661) 326-3979
~.
~ < ,~ Fax: (661) 872-2171
FACILITY NAME INSPECTIPN DAT INSPECTION TIME
ADDRESS ~• i ~ PHONE NO. NO OF EMPLOYEES
2 ~-) i S ~ s t- ~2~ - ZSZ-
FACILITY CONTACT BUSINESS ID NUMBER
15-021-d1.5-n~-i "~
f- --- _- _ _ ~.
~ Section 1: Business Plan and Inventory Program
e e
~y _ ~~~^ ROUTINE l~. 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
^ SITE DIAGRAM ADEQUATE & ON HAND
1
a~~,. ',
-vV~
ANY HAZAR`DIO~US WASTE ON ITE? -'YES ^ NO
EXPLAIN: -v~~~" ~Ix~~
QUE/STIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979
C./~G2le-f "~J t
Inspector (Please Print) _ Fire Prevention / 1°` In /Shift of Site/Station # Business Site es onsible Pa (Pleas Print)
White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05
~P~~`~ _'~~`" CITY OF BAKERSFIELD FIRE DEPARTMENT
a;~~~,
FACILITY NAME GfZO sSrC o ~~ ~''~ -^~ ~ ~ h l7 ~ivr~s-f'ay INSPECTION DATE ~''` I F1 -~
Section 4: hazardous Waste Generator Program EPA ID # ~'~ ~ '~' i~ fi
^ Routine ~ Combined ^ Joint Agency ^Multl-Agency ^ Complaint ^ Re-inspection
OPERATION C V COMMENTS
Hazardous waste determination has been made
EPA ID Number I'i ~ ~ v~~
Authorized for waste treatment andlor storage
Reported release, fire, or explosion within 15 days of occurrence
Established or maintains a contingency plan and training
Hazardous waste accumulation time frames t G ~G~S o ~.~ O~
Containers in good condition and not leaking ~ '^{°" `'l ° ~ s
Containers are 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 ~
Secondary containment provided ~ r .~ ~t:xJ,~dl~ ~ ~~,tg tih
Conducts daily inspection of tanks
Used oil. not contaminated with other hazardous waste N ~
Proper management of lead acid batteries including labels 1~
Proper management of used oil filters
Transports hazazdous waste with completed manifest
Sends manifest copies to DTSC
Retains manifests for 3 years
Retains hazazdous waste analysis for 3 years
Retains copies of used oil receipts for 3 years N
Determines if waste is restricted from land disposal
=t/ompnance v=violation
Inspector: ~ ~~/~l~ `"'-~
Office of Environmental Services (661) 326-3979
White -Env. Svcs.
OFFICE OF ENVIRONMENTAL SERVICES
.y UNIFIED PROGRAM INSPECTION CHECKLIST
.~ty ~' ti P 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301
Pink -Business Copy
K.~..P d,t~ ~~!
Business Site Respo ible Patty
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