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BUSINESS PLAN 7/31/2006
~ ~ ~ ~ WALGREENS ' / ~ 4949 GOSFORD ROAD BAKER8FIELD FIRE DEPT. FIRE ORDINANCE VIOLATION. ~- ~~~~' D Preventioa Services ~. ~~ ~ ~Il~s® 900 Trtixtun Ave., Ste. 210. _ Bakersfield, CA 93301 Tel.: (661) 326-3979 X Fax: (661) 852-2171 OCCUPANCY~,r JfIJ='%'.„';.i;!r./s3..~ DISTRICT BLOCK NO. DATE ,' ~ , ~ ' TO .. TRLE FIRM OR DBA . COMPANY ADDRESS (CITY, STATE, ZIP) O ~ ~` BUSINESS PHONE HOME PHONE CORRECT ALL VIOLATIONS vaur~ox CHECKED BELOW xo. ~ - REQUIREMENTS 1 Remove and safely dispose of all hazardous refuse and dry vegetation on the-above premises (U.F.C.} COMBUSTIBLE WASTE /DRY 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 -------- immediatety accessible for,use in (area) _~~________-_w ~ (U.F.C.} g Re-charge all fire extinguishers. Fire extinguishers shall be serviced at least once each year, and/or 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.) FJREDOORSI g Repair all (cracks/holes/openings) in plaster in (location) ~___~________N___~_______________. Plastering shall return the surface to its original fire resistive condition. (U.B.C.) FlRE SEPARATIONS 10 Remove/repair (item & location) ___________________~______~__~_____~`_______w_. 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.) ELECTRK:ALAPPLU-NCES 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.) OUTDOOR BURNING 16 Violation of Section 1102 dealin with recreational fires or o en burnin U.F.C. FlTtEWORKS 17 Violations of Section 7602 U.F.C. or 8.49.040 of the Bakersfield Munici al Code B.M.C. re ardin fireworks. OTHER C ~..~^') ~1-.+° ~ _ y,! y ~ / .~ y;~ ... (p ~r 1 _ . i ~* .~°' f,/ f ,+ '° C/`.CL ' ! ~ f tj'i.. ~ ¢~~Sy}~t~.~lt""' ~f +rCw~ f ~ l f~ o~•a• j~j~~r~'~'...T_.3 s Y_~a~ _ ~%•~! ,"rl~l°~ ~~ fir' 'ir ~ ~' ~r=~i`~~.~ I' i ~ ON (DATE) `' - .~ ~' = ~ `;. AN INSPECTK)N WILL BE MADE, IF NO COMPLIANCE HAS BEEN MADE, ADDITIONAL REGULATORY ACTION MAY BE INITIATED. PERt>Wi pECEMIp MpiK:E OP VIOLATION O RCE T R WI BE E T BY RTI ED M L PR D A N DA E lpN11TURE AFTER VIOLATIONS ARE CORRECTED, RETURN THIS NOTICE BY MAIL OR IN PERSON TO: BY ORDER OF THE FOtE CN~F /~~( .,,+{ ~ F ~•i. a DATE COMR.E7~ 1 - "~ BAKERSFIELD FIRE DEPT. OFFICE OF PREVENTION SERVICES 900 TRUXTUN AVE., SUITE 210 ~ BAKERSFIELD, CA 93301 _ ' " t sasvECroR sroNATURE ~°~Dc C.F.C. CALIFORNUI FHtE CODE usc.. uNroRwl eutwa-o coDE B.M.C. BAKER9FIELD MuNIC~AL CODE NFPA NATIONAL F6tE PROTECTION AstKIC1ATxN1 NE.C.- NATIONAL ELECTRIC CODE sIONATVIIE .. - - ~ ,,~ ~': -' - ~~•j ~ ;~,;F,.°'`~~ White - CustomerlOriginat _ , _. .-Yellow .Statiotr:Copy,+ Pink - ProverMioh Services F01818 1REV. ovos/ i~~ . PC-~ ~aF~1~~ ~_. .•' r ~. + WALGREENS 7909 ______________________________________ SiteID: 015-021-002984 + Manager BRAD HAGGARD Location: 4949 GOSFORD RD City BAKERSFIELD BusPhone: (661) 858-0215 Map 123 CommHaz Low Grid: 17D FacUnits: 1 AOV: CommCode: BFD STA 09 SIC Code: Jr~~~ ~i~~l ~.3fS~{ EPA Numb : ~ ~/~- DunnBrad : Gf ~ - ~ D~ - ~ (psi i 1~IS~"G~ Emergency Contact / Title Emergency Contact / T tle, BRAD HAGGARD / STARE MANAGER eq - l ~ l Mq~ R P~~ Business Phone: (661) 853-0215x i i ~ Business Phon~: ~ roper U~ 24-Hour Phone (661) 665-9456x 24-Hour Phone (56 _, ___ __9`~R ~~~ Pager Phone ( ) ~~ 1~ - x Pager Phone ( ) - x ~p~., ~JDD Hazmat Hazards: Fire Press React ImmHlth Contact CHRISTINA CHIAP:PETTA Phone: (847) 914-3195x MailAddr: 200 WILMOT RD MS2171 State: IL City DEERFIELD Zip 60015 Owner WALGREENS CORP Phone: (847) 914-3853x Address 200 WILMOT RD State: IL City DEERFIELD Zip 60015 Period : -~ ~I ~ ~ ~ ~' to ~~ ~ ~ ~~ 7 TotalASTs • _ ~ Gal Preparer:O..p~~p~y~ M-~f~~C~ f~J~1~}'f~' ~~I~~~ehJ ~o~' TotalUSTs: _ ~ Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ua ~ r~rA CTS r'~T ~ase~ ~~,~ --rf,r int~uiry nt th~rse individuals responsible fa3 ;:at;;.~i4~irg t:~ts information, I certify :~rrder p8t'aity c~? i~,.4v ir~ar i have ~rersonaily examined ~}nd air; terr,iii€~r ;nritFs tt~e information ,~~.~brritted rxr;c~ ~~iiEVks Ei~~; i;~formatian is true, 2iG~LiY' .°ezd wt:ir;1~lw,t&9. C ,~ ~i~=?rat ,.._.,,~-..,.._.._ { Ste ENT'D A U G 13 2006 ~~~` 5 -1- 03/10/2006 CALIF^RNIA ANNOTATED SITE MAP I BUSINESS NAME: WALGREENS #7909 I 4949 G^SF^RD SITE ADDRESS: BAKERSFIELD, R^AD I CA 93313 Map #:1 ^F 2 A B C D E F G H I 5 6 f° 1 2 3 4 O Q ~----~ ~. ~ ~~i -' -- i Y X ~ . j"i HELIUM TANKS FIRST AID KIT O ELECTRIC PANEL O WATER MAIN O GAS MAIN FIRE EXTINGUISHER a FL^OR DRAIN a-zz REFRIGERANT EMERGENCY EQUIPMENT LB LOCK BOX SK SPILL KIT ALIF^RNIA ANNOTATED SITE MAP BUSINESS NAME: WALGREENS #7909 SITE ADDRESS: 4949 G^SF^RD BAKERSFIELD, ROAD CA 93313 Map #:2 ^F 2 A B C D E F G H I 1 2 3 4 5 6 f° x o g~ O 8 ® ,•I 0 0 M k P9Cf7~VO P16J' f0 t f6 N O ~ 1 SCA E~ NOT TO SCALE 3E 07/20/2006 -~ SAFE REFUGE AREA 1-i FIRE HYDRANT ® STORM DRAIN Y X -~ _ -. ~~~-~J BUSINESS ACTIVITIES KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT 27UU M STREET, SUITE 300 l)nified Program Consolidated Form (l1pCF} RAKERSFIELD, ca 93301 FACILITY INFORMATION 661 862-8700 Fax 661 862-8701 Pa e 1 of 4 I. FACILITY IDENTIFICATION FACILITY ID # ~ EPA ID # (Hazardous Waste Only) BUSINESS NAME (Same as f=acility Name of DBA-Doing Business As) Walgreens #7909 Q Q II. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, please submit the Business Owner/Operator Identification page (KC Form 2730). QQ Does our facilit .. If Yes, lease com fete these a es of the UPCF.... A. HAZARDOUS MATERIALS Have on stte (for any purpose) hazardous materials at or above 55 HAZARDOUS MATERIALS INVENTORY - gallons for liquids, 500 pounds for solids, or 200 cubic feet for CHEMICAL DESCRIPTION (xC Form 2731) compressed gases (include liquids in ASTs and USTs); or the ®yES ^ NO 4 CONSOLIDATED CONTINGENCY PLAN applicable Federal threshold quantity for an extremely hazardous (KC Form 2733) substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is SITE MAP (xC Form z73a) required pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (KC Form n) 1. Own or operate underground storage tanks? ^YES ®NO 5 UST TANK (one page per tank) (xc Form u) 2. Intend to upgrade existing or install new USTS? ^YES ®NO 6 UST FACILITY UST TANK (one per tank) UST INSTALLATION - CER i'IFICATE OF COMPLIANCE (one page per tank) (KC Form C) 3. Need to report closing a UST? ^YES ®NO 7 UST TANK (closure portion -one pagc per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above a total capacity for the facility of greater than 1,320 gallons? ^yES ®NO 8 NO FORM REQUIRED TO KCEFISD D. HAZARDOUS WASTE 1. Generate hazardous waste? ®YES ^ NO 9 EPA ID NUMBER provide at the top of this page WASTE GENERATOR FORM (KC Fom, 2735) 2. Recycle more than 100 kg/month of excluded or exempted recyclable materials (per HSC 25143.2)? ^YES ®NO 10 RECYCLABLE MATERIALS REPORT (one per recycler) (KC Form 2732) 3. Treat hazardous waste on site? ~' ~ ~ ~Q06 ' ' ^YES ®NO I 1 ONSiTE HAZARDOUS WASTE TREATMENT-FACILITY KC 772t D ~q EN T ,tl ( Form t ) ONSITE HAZARDOUS WASTE TREATMENT -UNIT (one pagc per unit) (KC Form 1772u) 4. Treatment subject to finaricial assurance requirements (for ^YES ® NO 12 CERT[F1CA"PION OF FINANCIAL Permit by Rule and Conditional Authorization)? ASSURANCE (KC Fom, t23z> 5. Consolidate hazardous waste generated at a remote site? ^YES ®NO 13 REMOTE WASTE /CONSOLIDATION SITE ANNUAL NOTIFICATION (KC Form t tee) 6. Need to report the closure/removal of a tank that was classified as ~ yES ®NO 14 HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned onsite? CERTIFICATION (KC Fomt t2a9) E. LOCAL REQUIREMENTS is Have Regulated Substances (RS) stored on site at greater than the threshold REGULATED SUBSTANCES quantities established by the California Accidental Release Program ^YES ®NO 15 REGISTRATION (KC Form 2736) (Cal ARP)? A KS is any substance listed in Section 2770.5 of CCR Title 19, Division 2, Chapter 4.5. RISK MANAGEMENT PLAN (when required) ,, ~V BUSINESS OWNER/OPERATOR IDENTIFICATION KERN COUNTY ENVIRONMENTAL HEALTH SEKVICES UEYAKfMN:N'1' 2700 M STREET, SUITE 300 Unified Program Consolidated Form (UPCF) BAKERSFIELD, CA 93301 FACILITY INFORMATION 661 862-8700 Fax 661 862-8701 ® NEW BUSINESS ^ OUT OF BUSINESS ^ REVISE/UPDATE (EFFECTIVE / / ) Page? of 4 I. IDENTIFICATION FACILITY ID# t BEGINNING DATE too ENDING DATE tot 8/29/05 8/29/06 BUSINESS NAME (s?r:x as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE toz Walgreens #7909 (661) 858-0215 BUSINESS SITE ADDRESS 103 4949 Gosford Rd. CITY 104 CA ZIP CODE tos Bakersfield 93313 DUN & BRADSTREET 106 SlC CODE (4 digit #) t°7 93-103-6651 5912/7384 COUNTY tos Kern Count BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE t 10 Walgreens Corporation (847) 914-3853 II. BUSINESS OWNER OWNER NAME t t t OWNER PHONE t t2 Walgreens Corporation (847) 914-3853 OWNER MAILING AllDRESS t is 200 Wilmot Road CITY 114 STATE tt5 ZIP CODE tte Deerfield IL 60015 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 CONTACT PHONE tts Christina Chiappetta (847) 914-3195 CONTACT MAILING ADDRESS t t9 200 Wilmot Road , MS # 2171 CITY 120 STATE 12t ZIP CODE t22 Deerfield IL 60015 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME tea Brad Haggard Kimberly Jantz TITLE t24 TITLE 129 Store Manager Photo Supervisor BUS[NESS PHONE 125 BUSINESS PHONE tso (661)858-0215 (714)225-0674 24-HOUR PHONE t26 24-HOUR PHONE 131 (661)665-9456 (714)225-0674 PAGER# t27 PAGER# tsz N/A N/A ADllIT[ONAL LOCALLY COLLECTED INFORMATION: t3s APN: 4 9 7_ 1 3 0_ 3 4_ 0 0_ p Environmental Contact E-Mail Address: Christina.chiappetta@walgreens.com Certification: 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 believe the information is true, accurate, and complete. SIGNATURE OFOWNER/OPER O DESIGNAT REPRESENTATIVE DATE I~4 NAME OF DOCUMENT PREPARER 135 Jessie Blaydes - 3E Company Regulatory NAME OF SIGNER (print) 136 T1TL OF SIGNER 137 Dean Jarret Divisional Merchandise Manager ~,, HAZARDOUS MATERIALS INVENTORY - cHEMrcaL nESC~rTION KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT UniFed Program Consolidated Form (U PCF) 2700 M STREET, S[11TE 300 HAZARDOUS MATERIALS BAKERSFIELD, CA 93301 661 862-8700 FaX 661 862-8701 (one page per material prr building ur ;uca) ®ADD ^ DELETE ^ REV 1SE ''-0° Page _ of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 Walgreens #7909 CHEMICAL LOCATION 2Q1 CHEMICAL LOCATION CONFIDENTIAL EPCRA zo2 Retail Sales Floor (In Refrigeration System) ^ YES ® No j , t MAP# (optional) 203 GRID# (optionap 204 FACILITY ID # ! I 1 G-4,5,6 II. CHEMICAL INFORMATION CHEMICAL NAME ''-05 TRADE SECRET Yes No 'lob Chlorodifluoromethane I(Subject to EPCRA, refer to instructions COMMON NAME 207 208 EHS' ^ Yes ®No Refrigerant (R-22) CA$# 209 'tf EHS if "Yes', all amounts below must be in pounds 75-45-6 FIRE CODE HAZARD CLASSES (Notcu:rentlyrequiredby KCEHSD) 210 NFG, OHH, IRR HAZARDOUS MATERIAL 211 TYPE (Check one item only) ®a. PURE ^ b. MIXTURE ^ c. WASTE RADIOACTIVE ^ Yes ®No 2t2 CURIES 213 PHYSICAL STATE (Check one item only) ^ a. SOLID ^ b. LIQUID ®c. GAS Zia LARGEST CONTAINER 1708 2i5 FED HAZARD CATEGORIES 2 t a (Check all that apply) ^ a. FIRE ^ b. REACTIVE $f c. PRESSURE RELEASE $f d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT zl7 MAXIMUM DAILY AMOUNT eta ANNUAL WASTE AMOUNT 2i° STATE WASTE CODE '-''-0 1708 1708 0 N/A 221 DAYS ON SITE: -''-z UNITS* ^ a. GALLONS ®b. CUBIC FEET ^ c. POUNDS ^ d. TONS Check one item onl ' If EHS, amount must be in ands. 365 sTOxAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIClNONME"fALLIC DRUM ^ i. FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ® r. OTH ER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN In Refrigeration System ^ d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ^ a. AMBIENT ®b. ABOVE AMBIENT ^ c. BELOW AMBIENT 22a STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I zzb zz7 ^ Yes ^ No zza z29 2 230 23] ^ Yes ^ NO 232 233 j 234 235 ^ Yes ^ NO 236 237 4 '-3a 239 ^ Yes ^ No Iao zat 5 zaz za3 ^ Yes ^ No zaa gas If more hazardous components are present et greater than I % by weight if non-carcinageniq or O.l % by weight if carcinogenic, attach addttlonal sheets of paper capturing the required Infarmatioo. ADDITIONAL LOCALLY COLLECTED INFORMATION lab If EPCRA Please Si Here HAZARDOUS MATERIALS INVENTORY - cHENUCA><, nESCRirT><oN KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Consolidated Form (U PCF) 2700 M STREET, S[JITE 300 HAZARDOUS MATERIALS BAKERSFIELD, CA 93301 661 862-8700 FaX 661 862-8701 (one page per mrterial prr building ur area) ®ADD ^ DELETE ^ REV ISE zoo Page _ of_ I. FACILITY INFORMATION DUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 Walgreens #7909 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA zo2 Office Area ^ YES ® NO I I MAP# (optionap 203 GRID# (optionap zoo FACILITY ID # ~ I 1 G-6 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes No zoe Helium If Subject to EPCRA, refer to instructions COMMON NAME zoo EHS* ^ Yes ®No 2os Helium CA$# 209 'If EHS if "Yes', all amounts below must be in pounds 7440-59-7 FIRE CODE HAZARD CLASSES (Notcusentlyrequiredby KCEHSD) z1o NFG, OHH HAZARDOUS MATERIAL TYPE (Check one item only) ®a. PURE ^ b. MIXTURE ^ c. WASTE 21 I RADIOACTIVE ^ Yes ®No 212 CURIES .13 PHYSICAL STATE its (Check one item only) ^ a. SOLID ^ b. LIQUID ®c. GAS 214 LARGEST CONTAINER 21,360 FED HAZARD CATEGORIES 216 (Check all that apply) ^ a. FIRE ^ b. REACTIVE $f c. PRESSURE RELEASE ^ d. ACUTE HEALTH ®e. CHRONIC HEALTH AVERAGE DAILY AMOUNT -'I~ MAXIMUM DAILY AMOUNT z1s ANNUM: WASTE AiVIOUNT z19 STATE WASTE CODE zzo 21,360 42,720 0 N/A zzI DAYS ON S[TE: zzz UNITS' ^ a. GALLONS ®b. CUBIC FEET ^ c. POUNDS ^ d. TONS Check one item onl * If EHS, amount must be in ands. 365 STORAGE CONTAINER ^ a. ABOVE GROUND TANK ^ e. PLASTIC/NONME"rALLIC DRUM ^ i. FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTH ER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ^ d. STEEL DRUM ^ h. SILO ® 1. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ^ a. AMBIENT ®b. ABOVE AMBIENT ^ c. BELOW AMBIENT zza STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC zz5 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I zz6 zn ^ Yes ^ No zza zz9 2 230 231 ^ Yes ^ NO 232 233 3 z3a z35 ^ Yes ^ No z3c z3~ Q 238 239 ^ Yes ^ NO 240 241 $ 242 243 ^ YeS ^ NO 244 245 If more hazardous components are present at greater than t % by weight it non-carcinogenic, or 0.1 % by weight if carcinogenic, attach addttlonal sheets of paper caplurtog the regalred Information. ADDITIONAL LOCALLY COLLECTED INFORMATION zas [f EPCRA Please Si Here CONSOLIDATED CONTINGENCY PLAN KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT Unified Program Form 2700 M STREET, SUITE 300 COVER PAGE BAKERSFIELD, CA 93301 661 862-8700 Fax 661 862-8701 Pa e 1 of 1 1. FACILITY IDENTIFICATION FACILITY ID # ~ i EPA ID # (Hazardous Waste Only) z I ~ i N/A as Facility Name of DBA Domg Business As) Walgreens #7909 The Consolidated Contingency Plan provides businesses a format to comply with the emergency planning requirements of the following two written hazardous materials emergency response plans required in California: 4 Hazardous Materials Business Plan (HSC Chapter 6.95 Section 25504 (b) and 19 CCR Sections 2729-2732), 4 Hazardous Waste Generator Contingency Plan (22 CCR Section 66264.50, and, This format is designed to reduce duplication in the preparation and use of emergency response plans at the same facility, and to improve the coordination between facility response personnel and local, state and federal emergency responders during an emergency. A copy of the plan shall be submitted to this Department and at least one copy of the plan shall be maintained at the facility for use in the event of an emergency and for inspection by the local agency. Describe below where a copy of your Contingency Plan, including the hazardous material inventories, Training Records, and Site Map(s), are located at your business: Manager's Office PLAN CERTIFICATION / certify under penalty of law that 1 have personally examined and 1 am familiar with the information provided by this plan and to the best of my knowledge the information is accurate, complete, and true. Printed Name of Owner/ Operator Title of Owner/Operator Dean Jarret Divisional Merch ndis Manager Signature of Owner/ Operator Date / v We appreciate the effort of local businesses in completing these plans and are available to assist in any manner. If you have any questions, please contact this Department at (661) 862-8700. ADVISORY The site-specific Contingency Plan is the facility's plan for handling emergencies and shall be implemented immediately whenever there is a fire, explosion, or release of hazardous materials or waste that could threaten human health and/or the environment. The contingency plan shall be reviewed, and immediately amended, if necessary, whenever: Q The plan fails in an emergency 4 The facility changes in its design, construction, operation, maintenance, or other circumstances in a way that materially increases the potential for fires, explosions, or releases of hazardous waste or hazardous waste constituents, or changes the response necessary in an emergency a List of emergency coordinators changes 4 List of emergency equipment changes Submit a copy of any updates or changes to this Department. II. EMERGE NCY CONTACTS PRIMARY SECONDARY NAME 123 NAME 128 Brad Haggard Kimberly Jantz TITLE 124 TITLE 129 Store Manager Photo Supervisor BUSINESS PHONE 125 BUSINESS PHONE 130 (661)858-0215 (714)225-0674 24-HOUR PHONE 126 24-HOUR PHONE 131 (661)665-9456 (714)225-0674 PAGER # 127 PAGER # 132 N/A N/A Ili. EMERGENCY RESPONSE PLANS AND PROCEDURES A. Notifications Your business is required by State Law to provide an immediate verbal report of any release or threatened release of a hazardous material to local fire emergency response personnel, this Department, and the Office of Emergency Services. If you have a release or threatened release of hazardous materials, immediately call: FIRE/PARAMEDICS/POLICE/SHERIFF PHONE: 911 AFTER the local emergency response personnel are notified, you shall then notify this Department and the Office of Emergency Services. Kern County Environmental Health Department: (661) 862-8700 or after hours, call Dispatch at (661) 861-2521 State Office of Emergency Service: (800) 852-7550 or (916) 262-1621 National Response Center: (800) 424-8802 Information to be provided during Notification: d Your Name and the Telephone Number from where you are calling. 4 Exact address of the release or threatened release. 4 Date, time, cause, and type of incident (e.g. fire, air release, spill etc.) d Material and quantity of the release, to the extent known. d Current condition of the facility. d Extent of injuries, if any. 4 Possible hazards to public health and/ or the environment outside of the facility. B. Emer enc Medical Facilit List the closest emergency medical facility that will be used by your business in the event of an accident of injury caused b a release or threatened release of a hazardous material HOSPITAL/CLINIC: PHONE NO: Mercy Medical Center (661}663-6000 ADDRESS: 400 Old River Rd. CITY: ZIP CODE: Bakersfield, CA 93311 C. Private Emer enc Res onse DOES YOUR BUSINESS HAVE A PRIVATE ON-SITE EMERGENCY RESPONSE TEAM? ^ Yes ®No If yes, provide an attachment that describes what policies and procedures your business will follow to notify your on-site emer enc res onse team in the event of a release or threatened release of hazardous materials. CLEANUP/DISPOSAL CONTRACTOR List the contractor that will provide cleanup services in the event of a release. NAME OF CONTRACTOR: PHONE NO: Waste contractors will be dispatched by Walgreens Corporate office. - - ADDRESS: CITY: ZIP CODE: D. Arran ements with Emer enc Res onders If you have made special (i.e. contractual) arrangements with any police department, fire department, hospital, contractor, or State or local emergency response team to coordinate emergency services, describe those arrangements in the space below: No special arrangements have been made with local agencies. E. Evacuation Plan 1. The following alarm signal(s) will be used to begin evacuation of the facility (check all which apply): ®Verbal ®Telephone (including cellular) ®Alarm System ®Public Address System ^ Intercom ^ Pagers ^, Portable Radio ^ Other (specify): 2. ®Evacuation map is prominently displayed throughout the facility. 3. ®Name of individual(s) responsible for coordinating evacuation including spreading the alarm and confirming the business has been evacuated: Store Manager or manager on duty F. Earth uake Vulnerabilit Identify areas of the facility where releases could occur or would require immediate inspection or isolation because of the vulnerability to earthquake related ground motion. ® Hazardous Waste/ Hazardous Materials Storage Areas ^ Production Floor ^ Process Lines ^ Bench/ Lab ^ Waste Treatment ® Other: Sales Floor Identify mechanical systems where releases could occur or would require immediate inspection or isolation because of the vulnerability to earthquake related ground motion. ® Utilities ^ Sprinkler Systems ^ Cabinets ® Shelves ® Racks ^ Pressure Vessels ® Gas Cylinders ^ Tanks ^ Process Piping ® Shutoff Valves ^ Other: G. Emer enc Procedures Briefly describe your business standard operating procedures in the event of a release or threatened release of hazardous materials/wastes: 1. PREVENTION (prevent the spill/release) -Consider the types of spills/releases associated with the hazardous materials/wastes present at your facility. What actions does your business take to prevent these spills/releases from occurrin ?You ma include a discussion of safet and stora a rocedures. In order to prevent a release from occurring all hazardous materials are kept in their original containers and store personnel visually inspect products on a daily basis. 2. MITIGATION (stop the release/spill) -Describe what actions are taken to reduce the harm or the damage to person(s), property, or the environment, and prevent what has occurred from getting worse or spreading. What is your immediate res onse to a leak, s ill, fire, ex losion, or airborne release at our business? In the event of a spill, all products will be cleaned up using in-house equipment (e.g. Absorbents, Brooms, Gloves, etc.). Products are disposed of according to state and federal regulations. If it is safe to do so, employees will attempt to extinguish fires with fire extinguishers in the facility. The manager on duty will be responsible for contacting 9-I-1 if the fire is uncontainable or out of control. 3. ABATEMENT (clean up the spill/release) -Describe what you would do to clean up the spill/release. How do you handle the com lete rocess of cleanin u and dis osin of released materials at our facilit ? In the event of a spill, all products will be cleaned up using in-house equipment (e.g. Absorbents, Brooms, Gloves, etc.). Products are disposed of according to state and federal regulations. In cases where a HazMat spill exceeds the capabilities of on-site resources, capabilities or training, and/or poses a special or unique hazard to life, safety or the environment, management will ca11911 and, if applicable, the Office of Emergency Services at (800) 852-7550. In conjunction with this notification, an external contractor, capable of safely cleaning up the spill, will be summoned to the site. IV. Emergency Equipment 22 CCR, Section 66265.52(e) [as referenced by Section 66262.34(a)(3)] requires that emergency equipment at the facility be listed. Completion of the following Emergency Equipment Inventory Table meets this requirement. EMERGENCY EQUIPMENT INVENTOR Y TABLE 1. Equipment Cate or 2. Equipment T e 3. Location 4. Descri tion* Personal ^ Cartridge Respirators PrOteCtlVe, ^Chemical Monitoring Equipment (describe) Equipment, ^ Chemical Protective Aprons/Coats Safety ^ Chemical Protective Boots Equipment, ®Chemicat Protective Gloves 1 Hour Photo Ru er and ^ Chemical Protective Suits (describe) FIrSt Aid ^Face Shields Equipment ®FirstAid Kits/Stations (describe) OfficeBreakRoom Basic First Aid Supplies ^ Hard Hats ^Plumbed Eye Wash Stations ® Portable Eye Wash Kits (i.e. bottle e) 1 Hour Photo Bottle Type ^ Respirator Cartridges (describe) ^ Safet Glasses/Splash Goggles ^ Safety Showers ^ Self-Contained Breathing Apparatuses (SCBA) ^ Other (describe) Fire ®Automatic Fire S tinkler S stems Throughout Extinguishing ®Fire Alarm Boxes/Stations Throughout Automatic fire alarms Systems ®Fire Extinguisher Systems (describe) Throughout ABC rated ^ Other (describe) Spill ®Absorbents (describe) 1 Hour Photo Rags Control ^ Berms/Dikes (describe) Equipment ^ Decontamination Equi ment (describe) and ^ Emergenc Tanks (describe) Decontamination ^ Exhaust Hoods Equipment ^ Gas C lindens Leak Repair Kits (describe) ^ Neutralizers (describe) ^ Overpack Drums ^ Sum s (describe) ^ Other (describe) COmmUfllCatiOnS ^ Chemical Alarms (describe) and ®Intercoms/ PAS stems Throughout Alarm ^ Portable Radios Systems ®Telephones Throughout ^ Under round Tank Leak Detection Monitors ^ Other (describe) Additional Equipment (Use Additional Pages if Needed.) Describe the equipment and its capabilities. If applicable, specify any testing/maintenance procedures<ntervals. Attach additional pages, numbered appropriately, if needed. V. EMPLOYEE TRAINING All facilities which handle hazardous materials must have a current written employee training plan. The items listed below are required per Health and Safety Code Section 25504 (c) and Title 19 Section 2732. Training shall be provided: 4 Initially for all new employees. 4 Methods for Safe Handlin of Hazardous Materials. Note: These training programs may take into consideration the position of each employee. Facility personnel are trained as follows: 4 Familiarity with all plans and procedures specified in the Contingency Plan. 4 Methods for Safe Handling of Hazardous Materials. 4 Safety procedures in the event of a release or threatened release of a hazardous material. 4 Use of Emergency Response equipment and supplies under the control of the business. 4 Procedures for Coordination with local Emer enc Response Organizations. Additional training should include: 4 Internal alarm/notification procedures. 4 Evacuation/re-entry procedures and assembly point locations 4 Material Safety Data Sheet (MSDS) training including specific hazard(s) of each chemical to which em to ees ma be exposed, includin routes of ex osure (i. e. inhalation, in estion, absor tion . VI. HAZARDOUS WASTE GENERATOR TRAINING If your business is a hazardous waste generator, you are required to provide training in hazardous waste management for all workers who handle hazardous waste at your site (22 CCR §66265.16). You are also required to document training. The items below are required. EMPLOYEE TRAINING 4 Facility personnel will successfully complete training within six months after the date of their employment or assignment to a facility or to a new position at a facility. d Em to ees will not handle hazardous wastes without su envision until trained. TRAINING DOCUMENTATION The owner or operator must maintain the following documents and records at the facility: 4 Job title for each position at the facility that is related to hazardous waste management, and the names of the employee(s) filling the position(s). 4 Description for each position listed above (must include required skill, education, or other qualifications as well as duties of employees assigned to the position. 4 Description of type and amount of both introductory and continuing training given to each employee. 4 Records that document that the requirements for training or job experience have been met. 4 Current employees' training records (to be retained until closure of the facility). 4 Former em to ees' trainin records to be retained at least three ears after termination of emplo ment . HAZARDOUS WASTE GENERATOR KERfY COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTs11ENT CiniRed Program Form 2740 M STREET, SUITE 340 BAKERSFIELll, CA 93301 661)862-8740 Fax 661 862-8701 Fa e 1 of l I. FACILITY INFORMATION FACILI"tY ID # ~ EPA [D # (Hazardous Waste Only) /A BUSINESS NAME (Same as Facility Name of UBA-Doing Business As) 3 Walgreens #7909 # OF EMPLOYEES n 27 II. TYPE OF GENERATOR PLEASE CHECK THE BOX THAT APPLIES B RCRA GENERATOR (FEDERAL WASTE NON-RCRA GENERATOR CALIFORNIA WASTE ONLY) LARGE QUANTITY GENERATOR (>1000 KG HAZARDOUS WASTE PER MONTH ~ ~ SMALL QUANTITY GENERATOR (>I00 KG BUTQ000 KG HAZARDOUS WASTE PER MONTH) ~ ~ CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR (<100 KG HAZARDOUS WASTE PER MONTH) ~ III. WASTE STREAM IDENTIFICATLON PLEASE COMPLETE THE TABLE BELOW. (SEE INSTRUCTIONS ON THE BACK FOR CODES AND EXPLANATIONS) PROCESS C WASTE DI-SCRIP'r10\° D WASTE ID E AMOUNT F PER YEAR UNITS G STORAGE H METHOD DISPOSAL I METHOD Silver Recovery Photo Processing Waste 1 cert~ that the ir:forrnation provided herezn is true and accurate to the best of my knowledge. OWNERIOPERATOR NAh1L• ! Dean Jarret 04VNERIOPERATOR TITLE Divisional Merchandise Manager O WNER/OPERATOR SIGNATURE.. DATE n L 7 ~ v~ ALIFORNIA ANNOTATED SITE MAP I BUSINESS NAME WALGREENS #7909 (SITE ADDRESS 4949 GOSFORD ROAD BAKERSFIELD, CA ~ A B C D E F G H 1 2 3 4 5 6 f° Map #:1 I Y X -~ HELIUM TANKS F[RST AID KIT O ELECTRIC PANEL O WATER MAIN O GAS MAIN FIRE EXTINGUISHER a FLOOR DRAIN R-22 REFRIGERANT EMERGENCY EQUIPMENT LB LocK eax CALIF^RNIA ANNOTATED SITE MAP I BUSINESS NAME: WALGREENS #7909 (SITE ADDRESS: 4949 G^SF^RD BAKERSFIELD, ROAD I CA 93313 Ma #:2 I P A B C D E F G H I 1 z 3 4 5 6 ~' NO TH ~ ~ ~ ~ _~ w ~ ~ --~_ ~ ~ ~ ~ ~~ O O o ~ ~._.~ ~~ C~.V.,.~ ~i PACHECO OAD 1 SCA E~ 3E NOT TD SCALE SAFE REFUGE AREA I-i FIRE HYDRANT ® STORM DRAIN Y X ~ WALGREENS 7909 SiteID: 015-021-002984 Manager BRAD HAGGARD Location: 4949 GOSFORD RD City BAKERSFIELD CommCode: BFD STA 09 EPA Numb: BusPhone: (661) 858-0215 Map 123 CommHaz Low Grid: 17D FacUnits: 1 AOV: SIC Code:5912 -73F~ DunnBrad:93-103-6651 Emergency Contact / Title Emergency Contact / Title BRAD HAGGARD / STORE MANAGER AGNES MACAPAGAL / DIST PHOTO SUPR Business Phone: (661) 858-0215x Business Phone: (559) 307-7100x 24-Hour Phone (661) 665-9456x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Press ImmHlth DelHlth Contact 2Hi~3-A-CH3~i~'TA 3'C Oa 'Id ~b ~ 4~"~ ~ Phone : ~~ )~4~~~k Ma i lAddr : ~-6~@-W3~MO~ 1~D-M~S 23~-3_-~ t q ~ n eve . State : ~3~- G~ City DEE'Ei~-- ~y~ Zip : -~A3-5 q 20~~ Owner WALGREENS CORP Phone : ( 847 ) 914 ='3~5~x-221uy Address 200 WILMOT RD MS2171 State: IL City DEERFIELD Zip 60015 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT `!\ \~ ' _ l Based on my inquiry of those individuals respansilale for obtaining the information, I certify under penalty of law that f have personally examined and am familiar with the information submitted and believe the information is true, ENT'D MAR 2 7 2007 accurate, and complete. Signature Date -1- 02/20/2007 F WALGREENS 7909 SiteID: 015-021-002984 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP REFRIGERANT P IH DH G 258.00 FT3 Low HELIUM P IH G 220.00 FT3 Min -2- 02/20/2007 -3- 02/20/2007 w, ' F WALGREENS 7909 SiteID: 015-021-002984 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME REFRIGERANT Days On Site (R-22) 365 Location within this Facility Unit Map:l Grid:G-5 REF SYS ~ CAS# 75-45-6 STATE T TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas I Pure Above Ambient Ambient IN MACHINE/EQUIP AMOUNTS AT THIS LOCATION Largest Co258100rFT3 Daily 258100m FT3 I Daily 258r00e FT3 HAGKKLVUS 1.:V1~lYV1VL'1V"1'S %Wt. RS CAS# 100.00 Chlorodifluoromethane ~ No 75456 t1F~GHKL H5~1'',~51"11;1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH DH 3/0/0/ 2.2 Low ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME HELIUM Days On Site II 365 Location within this Facility Unit Map:l Grid:G-6 OFFICE CAS# 7440-59-7 ~GasATE TPureE ~-AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Co220100rFT3 Daily 220100m FT3 I Daily 110r00e FT3 ri1iG1-itCLVU~ ~.V1~irV1v1;1v1J %Wt. RS CAS# 100.00 Helium No 7440597 - riHGEiCCL 1~~.~tSJ.71~1~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH 2/0/0/ 2.2 Min -4- 02/20/2007 ;, F WALGREENS 7909 SiteID: 015-021-002984 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 03/20/2006 ~ 911 OR BAKERSFIELD FIRE DEPT Employee Notif./Evacuation 01/23/2006 INTERCOM EVACUATION TO FRONT OF BLDG, ACROSS PARKING LOT - 500 FEET Public Notif./Evacuation 01/23/2006 CONTACT PUBLIC AFFAIRS AT 217-554-8865 Emergency Medical Plan 08/15/2006 FIRST PERSON NOTIFIES MANAGEMENT MANAGEMENT NOTIFIES PROPER AUTHORITIES AND ASSIGNS TASKS AS NEEDED TO ENSURE SECURITY MERCY MEDICAL CENTER 400 OLD RIVER RD 663-6000 -5- 02/20/2007 Y~ F WALGREENS 7909 SiteID: 015-021-002984 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 01/23/2006 ~ IN ORDER TO PREVENT A RELEASE FROM OCCURRING, ALL HAZARDOUS MATERIALS ARE KEPT IN THEIR ORIGINAL CONTAINERS AND STORE PERSONNEL VISUALLY INSPECT PRODUCTS ON A DAILY BASIS. Release Containment 08/15/2006 WE DEAL WITH VERY FEW CHEMICALS AND USE SPARINGLY. ONLY CERTIFIED PERSONNEL ARE TO HANDLE THESE CHEMICALS. ALL ARE KEPT CONTAINED AND ARE OUT OF THE PUBLIC EYE. _ ___ Clean Up 08/15/2006 FIRST, THE AREA WILL BE CONTAINED; SECOND, PROPER AUTHORITIES WILL BE NOTIFIED WITH INSPECTIONS IN HAND; AND THIRD, FOLLOW CLEAN-UP PROCEDURES FOR PROPER CHEMICALS IN MSDS AS DESIGNATED. V1.11CL iCCaVULI.:C L"~C:l.1Vdl.1V11 -6- 02/20/2007 ,, . P WALGREENS 7909 SiteID: 015-021-002984 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ JYCl:1d1 LYdGdIC.15 Utility Shut-Offs 01/09/2007 NATURAL GAS/PROPANE: S EXT BY EMER EXIT ELECTRICAL: S SIDE OF BLDG ELECT RM ADJ TO PHARMACY WATER: S EXT BY EMER EXIT SPECIAL: ACADEMY 800-545-6655 OR 866-808-6685 LOCK BOX: E OF FRONT ENTR Fire ProteC./Avail. Water 01/09/2007 PRIVATE FIRE PROTECTION: BLDG IS PROTECTED BY HEAT-ACTIVATED SPRINKLERS/SMOKE DETECTORS/EMS NOTIFYING ALARM SYSTEM PROVIDED BY LOCAL ALARM COMPANY. FIRE HYDRANT: ONE BY FRONT ENTR ACROSS PARKING LOT & ONE REAR ENTR TO PARKING LOT ACROSS PHARMACY DRIVE-THRU. Building Occupancy Level 01/09/2007 500 EMPLOYEES -7- OZ/20/2007 <~ .. F WALGREENS 7909 SiteID: 015-021-002984 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 08/15/2006 ~ BRIEF SUNIMARY OF TRAINING PROGRAM: COMPUTER-BASED DISTANCE LEARNING PROGRAM AND COMPLETE OVERVIEW WITH ON-HAND LEARNING AND PASS OR FAIL TESTS OF MSDS. ALL PROPER REQUIRED TRAINING ALSO INCLUDE PROPER HANDLING, OSHA, EMERGENCY TRAINING, PREVENTION PROCEDURES, EMERGENCY EVACUATION, AND NOTIFICATION PROCEDURES, ETC. rctyC G Held for Future Use nciu ivi ru~uic v5c -8- 02/20/2007 ~s CALIFORNIA ANNDTATED SITE MAP BUSINESS NAME: WALGREENS #7909 SITE ADDRESS: 4949 GQSfQRD RDAD Ma #:1 BAKERSFIELD CA 9331 P . M~ A B C D E €' G ~~"H ~ I .... . Y NOTATED SITE MAP BUSINESS NAME= WALGREENS #7909 t. SITE ADBRESS= 4949 GI7SFCIRD RpAD Ma #.2 BAKERSFIEID CA 93313 P ~ B C D ~ ... , F G. M I~ 2 3 4 5 8 f° Y X --~- ALIFORNIA ANNOTATED SITE MAP BUSINESS NAME: WALGREENS #7909 SITE ADDRESS- 49A9 GOSFORD ROAD Mup #:l ~~,e„ ~~~ ~ e. ., ~~, ~~~~~ ~~~~ ~~~~ BAKER~SFIELD, CA 9331 A B C D _~.: E F G H j w J S 3 Y 5 8 f° .... J ~.. . ~ e. 1~ ~ ~~ _.£ ~.~ } ~.s .~ . - ~ ~ ? - i _ ~ ~.._ 1 ~~ `~~ ~.;.~.: ~ :. ~ -- _ z .~ .: :: _ a. ~: = - ~ _ -- ~ ~ E ;: ~... ._ . , t ~.~ ;.;.; ,:; ~ ~ _ # : , y j i.._..~ t _~ ~ , s.. ~_ J ( ~ 3 f -I ~~ra -.~ _ M•~.-y ~...x.. k f.~ 3 ~ ~ ....; ....v. .~ ^ S i ~ ~ ' ~ : ~, 1 { { t i 5 ~ { S$t { _ r _ i may :...•.... ._.: :..._: : ~! rF- ~. ... ~ •.,. t .L~. :=~~ l i~ ~.~-g ___._. y.. _.,.._. ~~°~ cif. ~ ~~ 1 3E ..~ Y X .,....~.=~. . ' CAEIF`CIRN dNOTATED SITE MAP BUSINESS NAME WALGREENS #7909 SITE ADDRESS ¢949 GGSFORD ROAD Mnp #~~ ~ 1 .. BAKERSFIELD CA 93313 Y A B C D. F F G H I ~~ I 2 3 4 5 ~' . ~ „J ,.: SAF$ REFUGE AREA i-~ FIBE IIXDRANT ® STORM DRAIN Y X ~ Walgreen Co. 49.49 Grosford Roads Bakersfield, CA 93313 - 661-858-0215 661-858-0239 Fax Brad Haggard Store Manager www.walgreens.com W~~~il~'r/1i/ii- t~ - .~ _ ., Eakersfield Fire Dept. IJNIFIE® PRC)GR,14AA INSPECTION CHECKLIST `° Enironmental services .. .. - _ ,~ . ~.: , ,:; ~,_; ~ ~~~-~.~-~.~~ _~ ~ ` 1.715 Chester Ave SECTION 1 Business Plan and Invento Pro ram ry 9 Bakersfield, CA 93~~ 1 ~~ 2 ~ 005 Tel: (661)326-3979 'I FACILITY N A ME N D TE INSPECTION TIME INS P ECT ~ ~ A/~ ~ ~ / p~ ADDRESS PHON No. No. of Employees FAC1LfTYCONTACT Business ID Number 15- 1- ~-c~s ' Section 1: Business Plan and {nventory Program 2,~ ^ Routine Combined ^ Joint Agency ^Mnlti-Agency ^ Complaint ^ Re-in ~% nce~ OPERATION V t l COMMEPITS ~.. ~~ \V=Vioa o n ~ ^ ^ APPROPRIATE PERMIT ON HAND ^ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ ^ VISIBLE ADDRESS ^ ^ CORRECT OCCUPANCY ^ ^ VERIFICATION OF INVENTORY MATERIALS °v• l'~ ~tX~2 ^ ^ VERIFICATION OF QUANTITIES ~'" ~~~ ^ ^ VERIFICATION OF LOCATION ~. ~ ~ l1~ PNdiU ^ ^ PROPER SEGREGATION OF MATERIAL ~ ~~ ---- ^ --- ---- -------- ------- --- -------- -------- - ___ ^ VERIFICATION OF MSDS AVAILABILITYE ---- -------- -------- -- -- - ...._._.-.- ~ -- --- ---. -- i ---- -- f~ - -.-. _.._ V~ - - -- -- -.. - -- ~ ~ - -- --- - -- ----- ^ ^ VERIFICATION OF HAT MAT TRAINING ^ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ ^ EMERGENCY PROCEDURES ADEQUATE ^ ^ CONTAINERS PROPERLY LABELED ^ ^ HOUSEKEEPING --- ------- ----- r _--- ---__ --- ---___._... -- ---- - ------ --...--- ---_--- ^ ^ FIRE PROTECTION ~ ^ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDQUS WASTE ON SITE: OYES ^ NO EXPLAIN: ~~ ~~~~ QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT (661 ~ 326-3979 r - t ~~ ~ __ _ __ _ _ _ Inspector (Please Print) Fi Prevention 1st-In/Shift of Site Business Site Re ' o arty (Please Print) N White -Environmental Services Yellow -Station Copy Pink -Business Copy ~. WALGREENS 7909 Manager BRAD HAGGARD Location: 4949 GOSFORD RD City BAKERSFIELD SiteID: 015-021-002984 BusPhone: (661) 858-0215 Map 123 CommHaz Low Grid: 17D FacUnits: 1 AOV: CommCode: BFD STA 09 EPA Numb: SIC Code:5912 DunnBrad:93-103-6651 Emergency Contact / Title Emergency Contact / Title BRAD HAGGARD / STORE MANAGER AGNES MACAPAGAL / DIST PHOTO SUPR Business Phone: (661) 8 58-0215x Business Phone: (559) 307-7100x 24-Hour Phone (661) 6 65-9456x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Press ImmHlth DelHlth Contact 3E CO °s REGULATORY DEPT Phone: (760) 602-8700x MailAddr: 1905 ASTON AVE State: CA City CARLSBAD Zip 92008 Owner WALGREENS CORP Phone: (847) 914-2264x Address 200 WILMOT RD MS2171 State: IL City DEERFIELD Zip 60015 Period to TotalASTs: Gal Preparers TotalUSTs: = Gal Certif ' d: RSs : No ParcelNo: Emergency Directives: PROG A - HAZMAT NT H ~~~ ~' D ~dO~ E~ sed an resncnr.i,;. %~y inquiry of Chase indi~~iau~is .? ~' ~~:r a~:~faining the informati + unc on, ! c:Lrtify r. !?^n4lty cf le~~.~ chat ! have s f's"~~anally x.~:nir~F. ,~ ,,., , rf a.n f~,ra;~liar ~fH~ith thc~ i ~tur~nc tifln ' r . ~ 4nd ;rr!`~~e the information is true, accu,4te, SIO; nature ~` ~/~ 7 Uate -1- 07/16/2007 '? F WALGREENS 7909 SiteID: 015-021-002984 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP REFRIGERANT HELIUM P P IH DH IH G G ~ 258.00 220.00 FT3 FT3 Low Min -2- 07/16/2007 -3- 07/16/2007 i ~ F WALGREENS 7909 SiteID: 015-021-002984 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME . REFRIGERANT Days On Site (R-22) 365 Location within this Facility Unit Map:l Grid:G-5 REF SYS CAS# 75-45-6 ~GasATE T TYPE T PRESSURE TEMPERATURE CONTAINER TYPE I Pure I Above Ambient Ambient IN MACHINE/EQUIP AMOUNTS AT THIS LOCATION Largest Container Daily Maximum ( Daily Average 258.00 FT3 258.00 FT3 258.00 FT3 t11jG1itCLVUJ ~.GinrViv~ivl~ oWt. RS CAS# 100.00 Chlorodifluoromethane No 75456 tYE~L+HKL 1-»J~.751~12S1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH DH 3/0/0/ 2.2 Low ~ Inventory Item 0003 COMMON NAME / CHEMICAL NAME HELIUM Location within this Facility Unit OFFICE STATE TYPE PRESSURE _ Gas Pure -Above Ambient Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map:l Grid:G-6 CAS# 7440-59-7 TEMPERATURE CONTAINER TYPE Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 220.00 FT3 220.00 FT3 110.00 FT3 ru~~s~sc~vua , ~.~i~irviv~iv la %Wt. RS CAS# 100.00 Helium No 7440597 t1E~GKKL H~7~~J~1~1~1V 1.'~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No ~ No/ Curies P IH 2/0/0/ 2.2 Min -4- 07/16/2007 {. F WALGREENS 7909 SitelD: 015-021-002984 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 03/20/2006 ~ 911 OR BAKERSFIELD'FIRE DEPT Employee Notif./Evacuation INTERCOM EVACUATION TO FRONT OF BLDG, ACROSS PARKING LOT - 500 FEET 01/23/2006 Public Notif./Evacuation CONTACT PUBLIC AFFAIRS AT 217-554-8865 01/23/2006 Emergency Medical Plan 03/27/2007 FIRST PERSON NOTIFIES MANAGEMENT MANAGEMENT NOTIFIES PROPER AUTHORITIES AND ASSIGNS TASKS AS NEEDED TO ENSURE SECURITY MERCY MEDICAL CENTER, 400 OLD RIVER RD, 663-6000 -5- 07/16/2007 P WALGREENS 7909 SiteID: 015-021-002984 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 01/23/2006 ~ IN ORDER TO PREVENT A RELEASE FROM OCCURRING, ALL HAZARDOUS MATERIALS ARE KEPT IN THEIR ORIGINAL CONTAINERS AND STORE PERSONNEL VISUALLY INSPECT PRODUCTS ON A DAILY BASIS. Release Containment 08/15/2006 WE DEAL WITH VERY FEW CHEMICALS AND USE SPARINGLY. ONLY CERTIFIED PERSONNEL ARE TO HANDLE THESE CHEMICALS. ALL ARE KEPT CONTAINED AND ARE OUT OF THE PUBLIC EYE. Clean Up 08/15/2006 FIRST, THE AREA WILL BE CONTAINED; SECOND, PROPER AUTHORITIES WILL BE NOTIFIED WITH INSPECTIONS IN HAND; AND THIRD, FOLLOW CLEAN-UP PROCEDURES FOR PROPER CHEMICALS IN MSDS AS DESIGNATED. Other Resource Activation -6- 07/16/2007 r '~ F WALGREENS 7909 SiteID: 015-021-002984 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ J~JCC:1d1 ildGdLC.iS Utility Shut-Offs 01/09/2007 NATURAL GAS/PROPANE: S EXT BY EMER EXIT ELECTRICAL: S SIDE OF BLDG ELECT RM ADJ TO PHARMACY WATER: S EXT BY EMER EXIT SPECIAL: ACADEMY 800-545-6655 OR 866-808-6685 LOCK BOX: E OF FRONT ENTR Fire Protec./Avail. Water 01/09/2007 PRIVATE FIRE PROTECTION: BLDG IS PROTECTED BY HEAT-ACTIVATED SPRINKLERS/SMOKE DETECTORS/EMS NOTIFYING ALARM SYSTEM PROVIDED BY LOCAL ALARM COMPANY. FIRE HYDRANT: ONE BY FRONT ENTR ACROSS PARKING LOT & ONE REAR ENTR TO PARKING LOT ACROSS PHARMACY DRIVE-THRU. Building Occupancy Level 500 EMPLOYEES 01/09/2007 -7- 07/16/2007 ~ ;, F WALGREENS 7909 SiteID: 015-021-002984 Fast Format ~ Training Overall Site ~ Employee Training 08/15/2006 BRIEF SUMMARY OF TRAINING PROGRAM: COMPUTER-BASED DISTANCE LEARNING PROGRAM AND COMPLETE OVERVIEW WITH ON-HAND LEARNING AND PASS OR FAIL TESTS OF MSDS. ALL PROPER REQUIRED TRAINING ALSO.INCLUDE PROPER HANDLING, OSHA, EMERGENCY TRAINING, PREVENTION PROCEDURES, EMERGENCY EVACUATION, AND NOTIFICATION PROCEDURES, ETC. 9 rcayC a Held for Future Use Held for Future Use -8- 07/16/2007 B E R S F I F/l~E aRrM D July 25, 2007 Ronald J. Fraze Fire Chief Gary Hutton Kirk Blair Dean Clason Howard H. Wines, III Director Prevention Services 1600 Truxtun Avenue, Suite 401 Bakersfield, CA 93301 PHONE: 661-326-3979 FAX: 661-852-2171 WALGREENS 7909 4949 GOSFORD RD BAKERSFIELD, CA 93313 ~5 ~~ ~~~~p~ 1. Fire extinguisher needs to be serviced per California Fire Code. 2. Need clearance in front of electrical panels. ENT~D ~ u ~ ~ ~ z~o~ Based on my inquiry of the deficiencies listed above and the individuals responsible for correcting the deficiencies, I certify under penalty of law that I have personally examined and am familiar with the above list of deficiencies and believe the deficiencies have been corrected and are true, accurate, and complete. ~~ ~ 8/00 Signature Date Jee~ ~srif't~ ~ Zoo~~zyy~~ea~~~o2 ~i~~ ~~ ~ ~ee~~2~r~ ,. ~;•~ _ ~l 0 ~~~ UNIFIED PROGRAM INSPECTION CHECKLIST;; SECTION 1: Business Plan and Inventory Program !s Prevention Services B e a s F t D 900 Truxtun Ave., Suite 210 f/RE Bakersfield, CA 93301 ARTM T Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME w 1 ~ ~ INSPECTION DATE tS'-i 3--a ~ INSPECTION TIME 1 ~~-I, ADDRESS r-i ~- ~ 9 vs tea( PH ~ E~~~ ©2/~ NO~ FEMPLOYEES FACILITY CONTACT BUSINESS ID NUMB15_021-~ 2~ 8 `/ .Section 1 Business Flan and lnventary Progralnrl ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (c=compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIfIeSS 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 ^ C~ HOUSEKEEPING Ne~ ^ ~ FIRE PROTECTION t ~~ t.~tt~, ~~S~er' rr S -v ~ecly, 4 ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN ^ YES ~ NO '~S QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 e.S. ~ ~,S 9/~ Inspector (Please Print) Fire Prevention / 1~` In /Shift f Site/Station # x~nro.~n ~v e~J usiness ite /Responsible Party (Ple se Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 :.~ .- ~P,~~` ^~`~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES ~ .y UNIFIED PROGRAM INSPECTION CHECKLIST ~~ 1715 Chester Ave., 3rd Floor, Bakersifield, CA 93301 FACILITY NAMEL~~~-~f~~ INSPECTION DATE ~ ~ o~ Section 4: Hazardous Waste Generator Program ^ Routine ~ Combined ^ Joint Agency EPA ID # ^ Multi-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made ~.~~ ~,,,C -~,~.,~~,,.,~~ pK 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 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 =t/ompuance v=viotanon Inspector: W ` ~~ Office of Environmental Services (661) 326-3979 White -Env. Svcs. r C Business S esponsible Party Pink -Business Copy ;~ B E R S F k. i3~ Plli<Q ~ R r~r r -..ir..,..4 ~~ . A K:...,- CITY OF I3AKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION ."~ -_ i (one loan per material per building or area) ~EW ^ ADD ^ DELETE ^ REVISE 200 Page _ of ' I. FACILITY INFORMATION ~ ~ _ - - -~ - ' BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) ~ - 3 -----1=`~/~~Csa..c~.~s._ ~ ?Sod CHEMICAL LOCATION 20 t ^ No ^ Yes ~ O L ( O 202 _ CON DENTI A CRA) EP __ .... _ L_~___._ ~ i ~~ i.. - ' i ~ ~ i~ ~ FACILITY ID # 1 MAP # optanaQ - ( 203 GRID # (optionan - ---~----------- 204 (,•~ i ~ ^-___ -__ _ ......_~1 ............._......_.._.____._.... - -- ~ . _.._._...._..._____. .. .. _._.._.. .._. _...._...._ ...__-.-_~_.___ il. Cr~EMICAL INFORMATION . 205 _ TRADE SECRET ^ Yes ^ No __ 206 CHEMICAL NAME /~~ C If Subject to EPCRA, refer to instructions i ---- --------_ _ __ _~. 207 . _.. _--- ---_------------ --- -- --_ COMMON NAME EHS' ^ Yes ^ No 208 CAS # ----~ ~ _._.---..-_. ..... _ _ . _ i _. . _ - 209 'If EHS it'Yes,' all amounts blow must tx in lbs. i FIRE CODE HAZARD CLASSES (Complete if requested by local fre chief i 210 TYPE _.__..____...._ . ........... .... -. -..... ~ ^ p PURE ^ m MIXTURE _. ~ ._.._. w WAS~O_ .. R•J?IOACTIVc _ ^ No ^ Yes 212 ...CURIES 2i3 PHYSICAL STATE ^ s SOLIDLIQUID ^ g GAS 2~q LARGEST CONTAINER ~ 215 FED HAZARD CATEGORIES ^ 1 FIRE ^ 2 REACTIVE ^ 3 PRESS JRE FtELE i.SE I 4 A :U'E HEALTH ~5 CHRONIC HEALTH 216 (Check all that apply) i. ANNUAL WASTE 217 ~d4XIMUti1 218 S P.VERAGE 219 ~ STATE WASTE CODE ~ ~ N ~ 220 AMOUNT DAILY AMOUNT DAILY AMOU T - UNITS' ~a GAL ^ d CU FT ^ Ib LBS ^ to TONS 221 DAYS ON SITE 222 ' If EHS, amount must be in lbs. I STORAGE CONTAINER `~ (Check all that apply) ^ a ABOVEGROUND TANK ! e PLASTIC/NONMETALLIC DRUM ^ i FIBER DRUM ^ m GLASS BOTTLE ^ q RAIL CAR 223 ~ ^ b UNDERGROUND TANK ^ f CAN ~, j BAG ^ n PLASTIC 80TTLE ^ r OTHER ' ^ c TANK INSIDE BUILDING ^ g CARBOY ^ k BOX ^ o TOTE BIN ^ d STEEL DRUM ^ h SILO ^ 1 CYLINDER ~ ^ o TANK WAGON ~, STORAGE PRESSURE AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT 224 STORAGETEMPERATURE ~ AMBIENT ^ as ABOVE AMBIENT ^ b3 BELOW AMBIENT ^ c CRYOGENIC 225 %Wf ':`; `. ' " HAZARDOUS COMPONENT EHS i ~ 1 226 ~ 227 I ^ Yes ^ No 228 2 230 23t ~ ^ Yes ^ No 232 i 3 23a i 235 ^ yes ^ No 236 4 238 239 ; ^ Yes ^ No 240 i I ~ .. . - -`---r---' -- ~ ~ - ~ - - -- . .. ... .. - - - 5 ~ 242 243 i^ Y N 244 ' _ ...._ ----------_._._.._..-~_--------._...._..._,._......__ .............._ __ ___... _..... ._.._.._. __.. .. ..~_...._..._e5 ._..-o--_ ..._~.__.--- III. SIGNATURE C1~ i r-- ----- --...___ __--------..__.._....._.._. _..... _ . .. _....- - - ------ PRINT NAME 8 TITLE OF AUTHORIZED COMPANY REPRESENTATIVE ~ ~ SIGNATURE CAS # 229 233 237 241 245 UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd