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HomeMy WebLinkAboutBUSINESS PLAN 7/19/2007~~, ~ :~ ~~' .~~~ ~~ PET~~ I~ivll~i; D~iS--- " u~~ 2520 H STREET f1 ''\ :~ PR$MIER FAMILY DENTISTRY SiteID: 015-021-002279 Manager PETER KIM BusPhone: (661) 324-1200 Location: 2520 H ST Map 103 CommHaz Minimal City BAKERSFIELD Grid: 30A FacUnits: 1 AOV: CommCode: BFD STA O1 SIC Code:8021 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title PETER KIM DDS / OWNER / Business Phone: (661) 324-1200x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact PETER KIM Phone: (661) 324-1200x MailAddr: 2520 H ST State: CA City BAKERSFIELD Zip 93301 Owner PETER KIM DDS Phone: (661) 324-1200x Address 2520 H 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 ~N~ .l~1~ ~ ~ ~~~' Based on my inouiry of those individuals resrc~ ~si;la fnr obtaining the i nformation, !certify und~;r penalty of law that 1 have personally examined and am farniliar w ith the information suElrnitted and t~lieve the information is true, accurat ,and comr~'ete. ..,-- _ - ~ ~~ ~ 7 Sign to a Date -1- 07/12/2007 F PREMIER FAMILY DENTISTRY SiteID: 015-021-002279 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ I Hazmat Common Name... ISpecHazIEPA Hazards) Frm I DailyMax IUnitIMCPI WASTE FIXER R L 5.00 GAL Minl -2- 07/12/2007 -3- 07/12/2007 :S ~ F PREMIER FAMILY DENTISTRY ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME WASTE FIXER Location within this Facility Unit UNDER DARKROOM SINK STATE TYPE PRESSURE Liquid TWaste Ambient SiteID: 015-021-002279 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: - CAS# TEMPERATURE CONTAINER TYPE Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 5.00 GAL 5.00 GAL 5.00 GAL - -- tly.~t~.ttl.~uu~ ~ul~irvlvr;lv~l~~ oWt. RS CAS# Silver No 7440224 riAGKttL H5~1";~~1~11'~1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 07/12/2007 ;~ F PREMIER FAMILY DENTISTRY SiteID: 015-021-002279 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 02/26/2007 ~ CALL X-RAY SOLUTION IF ANY SPILLS. _, r ~~ L'lll~.J1VYGG 1VV 1.11.~.G VGIIr UCLL1V11 i~ rlllJlll. 1VV 1.11. ~ P~VCL C. UC11.1 V11 Emergency Medical Plan 02/26/2007 FRONT OF BLDG PARKING LOT. -5- 07/12/2007 C L F PREMIER FAMILY DENTISTRY SiteID: 015-021-002279 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ iCC1CQAC r1CVCll l.1 V11 Release Containment 02/26/2007 TANK INSIDE A TUB IN CASE OF SPILL. Clean Up CALL X-RAY SOLUTIONS. 02/26/2007 Other Resource Activation -6- 07/12/2007 t* F PREMIER FAMILY DENTISTRY SiteID: 015-021-002279 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~ Special Hazards Utility Shut-Offs SHUT-OFFS W SIDE OF OFFICE - TURNED OFF EVERY NIGHT. 02/26/2007 Fire Protec./Avail. Water CALL FIRE DEPT OR 911. WATER IS AVAILABLE. 02/26/2007 DU11U111y Vl:l:u~JCilll.:y LCVC1 -7- 07/12/2007 ~ i 5~ F PREMIER FAMILY DENTISTRY SiteTD: 015-021-002279 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 02/26/2007 ~ BRIEF SUNIl~lARY OF TRAINING PROGRAM: STAFF ARE TRAINED TO ACT RIGHT AWAY IN ANY EMERGENCY OF SPILL BY CALLING 911 OR X-RAY SOLUTIONS. rayc ~. Held for Future Use _, r_ raciu ivi ru~.uic ~~c -8- 07/12/2007 ;~ Prevention Services - UI~IFI D~ PROGRAM INSPECTION CHECKLIST A F R s f , n 900 Trtixtun Ave.; Suite 210 Fr',RE Bakersfield; CA 93301 , SECTION 1: Business Plan and Inventory Program "'~'"' Tel.: (66i) 3zs=x9793_ eaN~ I Fax: (661) 872-2171 FACILITY NAME C ATE INSPECTIONQD l INSPECTION TIME J ~ ~ l v 1 ADDRESS • ~ i~ 2 S 20 -H S-t PHONE NO. 3 ~H ~ ~ zc~o NO OF E LOYEES FACILITY CONTACT BUSINESS ID NUMBER 15-021- ©IS-o~i^ Cp Section 1: Business Plan and Inventory Program ^ ROUTINE ~ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENT S ^~~~ APPROPRIATE PERMIT ON HAND n ~A.~-~- rf' t`e- aC1,%Mevs'~ P~ ! Vin ~' Q O ^ BUSIneSS 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 EST°D [„ i ~ ~ ~ Q ~„ 1.1 `. ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION '~.~ q lei ~ J AC ~~L "1 J N Cr vt J S ?~ ~c~ ^ SITE DIAGRAM ADEQUATE & ON HAND .L~°j c:J~i'~ ~ ANY HAZARDOUS WASTE ON SITE? ~C8 YES ^ NO ~~~~ ~'l~ Eu~ EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1" In /Shift of Site/Station # White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 ~~. ~0~~`- ~'~~°a CITY OF BAKERSFIELD FIRE DEPARTMENT ~`~ ~~ OFFICE OF ENVIRONMENTAL SERVICES $~' . ~ ~~ UNIFIED PROGRAM INSPECTION CHECKLIST `~`"~gti 1715 Chester Ave., 3rd Floor, Bakers>lield, CA 93301 FACILITY NAME ~ 1 ~ ~ Ds INSPECTION DATE ~/ ~ E 8 ~ ~ ~ Section 4: Hazardous Waste Generator Program EPA ID # ~ I/ ~- ~' ~F' ^ Routine 'I~ Combined ^ Joint Agency ^Muiti-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number ~ ~ ,ti., ~ 1 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 Ignitablelreactivetyaste located at least 50 feet from property line 1J „~ Secondary containment provided Conducts daily inspection of tanks Used oil. not contaminated with other hazardous waste N ~yK Proper management of lead acid batteries including labels N /~1 Proper management of used oil filters N ,a Transports hazazdous waste with completed manifest Sends manifest copies to DTSC 11 k _ ~~y Sc~ 1u~ a~~ 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;=c:ompnance v=vtolatton Inspector: . ~~~~/G t ~ 1 Office of Environmental Services (661) 326-3979 White -Env. Svcs. Bustnes Site nsible Party Pink -Business Copy `, T, KIM DDS PETER SiteID: 015-021-002279 Manager ; Location: 2520 H ST City BAKERSFIELD BusPhone: (661) 324-1200 Map 103 CommHaz Minimal Grid: 30A FacUnits: 1 AOV: CommCode: BFD STA O1 EPA Numb: SIC Code:8021 DunnBrad: Emergency Contact / Title ~ Emergency Contact / Title / ~ / Business Phone: ((D~,1) ~a~ - ~a~ Business Phone: ( ) - x 24-Hour Phone ( ) - x '~~ 24-Hour Phone ( ) - x Pager Phone ( )_ - x Pager Phone ( ) - x Hazmat Hazards: React Contact :, Phone: (661) 324-1200x MailAddr: 2520 H ST State: CA City BAKEFtSFIELD Zip 93301 Owner ~\VV1 Phone: (661) 324-1200x Address 2520 H 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 ~'N~~ ~~~ ~ ~ ~~~I based on my inq:.~iry of those individua's 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 ~ mplete. ~'! Signature Date -1- 02/02/2007 F KIM DDS PETER SiteID: 015-021-002279 ~ ~ 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- 02/02/2007 -3- 02/02/2007 F KIM DDS PETER SiteID: 015-021-002279 ~ ~ 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: UNDER DARKROOM SINK CAS# = STATE TYPE PRESSURE TEMPERATURE ~~ CONTAINER TYPE Liquid TWaste ~ Ambient ~ Ambient I PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL L7T r1T TT1l1TTA /'~/17~RT/~'ATTIT.Tmn - - - ruy~,rucLV V a ~.vi•trvtvr~ly 1 ~ °sWt. RS CAS# Silver No 7440224 L1tiGtiR1J H. 7JL~.7.71•1P~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 02/02/2007 F KIM DDS PETER SiteID: 015-021-002279 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ by Clll~y 1VV 1.111Ud1..1 V11 ~ ~s~~ ~ ~~ ~~ _, ,~ GIllYJ1Vy CC 1VV 1.11.. ~ I_'aVCLI:Udl.l Vll X t l1.AJ111.: 1VV 1.11 ~.GVdC~lld 1.1V11 PrlLLC11~. C11Uy 1°1CU1C:d1 Y1dil -5- 02/02/2007 F KIM DDS PETER SiteID: 015-021-002279 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention , X 1CCICQSC L.Vlll,d111111C11L dean up v~.ucL 1CC~VULI:C 1-lUl.1VdL1Ui1 -6- 02/02/2007 F KIM DDS PETER SiteID: 015-021-002279 ~ Fast Format ~ Site Emergency Factors Overall Site ~ ~Yc~:.~di nd~dl_u~ Utility Shut-Offs ~~~~ ~ IJ~'~c_ ~~ ~~~ (J 1'1lC t'LVI.CC:.~EiVd11 Wdl..Cl ~~~` 0 D U11u111y VIII: U~Jdlll:y LCVCl x -7- 02/02/2007 i., ~_ /" F KIMIDDS PETER SiteID: 015-021-002279 ~ Fast Format ~ ~~Training Overall Site ~ Alll~lllJyCC 1LCL1illilt,. `~'~,'~ btu, ~~ ~.~ s rayc c. racl.u tvi rul.ulC VSC nciu tvi r ul.uiC Usti -8- 02/02/2007 Uti ::. .. + KNERR DDS GARY ______________________________________ SiteID: 015-021-002300 + Manager Location: 2613 G ST City. BAKERSFIELD BusPhone: (661) 322-1948 Map 102 CommHaz Minimal Grid: 24D FacUnits: 1 AOV: CommCode: BFD STA Ol SIC Code:8021 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title GARY KNERR DDS / / Business Phone: (661) 322-1948x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact GARY KNERR DDS ~ Phone: (661) 322-1948x MailAddr: 2613 G ST State: CA City BAKERSFIELD Zip 93301 Owner GARY KNERR DDS Phone: (661) 322-1948x Address 2613 G ST State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: - Gal Preparers ~ TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: , E Di ti / mergency rec ves: ~, hh PROG'; H - HAZ WASTE GEN ~ V ~N~~ J U L ~ ~ 200 ~~ Based on my inquiry of those individuals ~ \ r©sponsible for obtaini the information, I certify ~~ under penalty of I w that I have personally ~~ exa fined a a familiar with the information $ ted d elieve 4he information is true, omplete. natu ~ Dat~ ~ -1- 05/18/2006