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Home My WebLink AboutBUSINESS PLAN0 u I'TBAKERSFIELD RADIOLOGY MED GRP --- - - _ ~ 2828 H STREET,_SUITE D __ ~I I BAKERSFIELD PATHOLOGY MED GROUP Manager DIANE NIEBLAS/STEVEN JACOBS Location: 2828 H ST D City BAKERSFIELD CommCode: BFD STA 01 EPA Numb: BusPhone: Map 102 Grid: 24C SIC Code: DunnBrad: SiteID: 015-021-002408 (661) 336-0622 CommHaz High FacUnits: 1 AOV: Emergency Contact / Title Emergency Contact / Title STEVEN FOGEL / PATHOLOGIST L GUINTO-MIRANDA / PATHOLOGIST Business Phone: (661) 336-0622x Business Phone: (661) 336-0622x 24-Hour Phone (661) 201-3648x 24-Hour Phone (661) 871-6383x Pager Phone ( ) - x Pager Phone (661) 201-9944x Hazmat Hazards: ImmHlth DelHlth Contact DIANE NIEBLAS /STEVEN JACOBS Phone: (661) 336-0622x MailAddr: 2828 H ST D State: CA City BAKERSFIELD Zip 93301 Owner MIRANDA JACOBS FOGEL MDS Phone: (661) 336-0622x Address 2828 H ST D 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 ENT'D .1 U L 19 2007 (3a.sc~d on my ingoiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am famil iar with the information submitted and believe the information is true, accurate, and complete. ~~~~ 7 Signature Date -1- 06/29/2007 t ~, BAKERSFIELD PATHOLOGY MED GROUP SiteID: 015-021-002408 Manager 1~1u~>/N-ehla~ , rn~f ~-~~~ ~aco~s "`° BusPhone: (661) 336-0622 Location: 2828 H ST D Map 102 CommHaz High City BAKERSFIELD Grid: 24C FacUnits: 1 AOV: CommCode: BFD STA Ol EPA Numb: SIC Code: DunnBrad: Emergency Contact STEVEN FOGEL Business Phone: 24-Hour Phone Pager Phone Hazmat Hazards: Title / PATHOLOGIST (661) 336-0622x (661) 201-3648x ( ) - x Emergency Contact L GUINTO-MIRANDA Business Phone: 24-Hour Phone Pager Phone Contact ~/~Ut~ I~IQ~/Qb G11t~.~ 5~~~ J~~s~~'d Phone: (661) 336-0622x MailAddr: 2828 H ST D State: CA City BAKERSFIELD Zip 93301 Owner MIRANDA JACOBS FOGEL MDS Phone: (661) 336-0622x Address 2828 H ST D State: CA City BAKERSFIELD Zip 93301 Period to Preparers Certif'd: ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN F3~~,ed on my inquiry of those individuals rc~;;por,Qlbie for obtaining the information, I certify under penalty of law that I have personally examin®d and am familiar with the information submitted and believe the information is true, accurate and complete. ~~~~~ a- ~~~~ Signature Date TotalASTs: _ TotalUSTs: _ RSs: No / Title / PATHOLOGIST (661) 336-0622x (661) 871-6383x (661) 201-9944x ImmHlth DelHltli ENT'D ~~D' ~ ~ ~QO~ Gall Gal -1- O1/25/~007 .~ F BAKERSFIELD PATHOLOGY MED GROUP SiteID: 015-021-0024018 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP FORMALDEHYDE E IH DH L 75.00 GAL ~T ALCOHOL L 80.00 GAL Mod -2- 01/25/2007 _3_ 01/25/2007 iY F BAKERSFIELD PATHOLOGY MED GROUP SiteID: 015-021-00240$ ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME .FORMALDEHYDE Days On Site 365 Location within this Facility Unit Map: Grid: ------- CAS# 50-00-0 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TWaste ~ Ambient ~ Ambient ~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 75.00 GAL 75.00 GAL 75.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 37.00 Formaldehyde (EPA) Yes 501700 14.00 Methanol No 67561 I11iGtitCL Li~ J.7tS.7.71~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH DH / / / Hi ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME ALCOHOL Days On Site 365 Location within this Facility Unit Map: Grid: CAS# Liquid TWaste -I Ambient~E ~ AmbientT~E ~ PLASTOICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 80.00 GAL 80.00 GAL 80.00 GAL ru~urucLV V a ~.vrirvl~~ly t u °sWt . RS CAS# 100.00 Isopropyl Alcohol No r 67630 i1tiL~riRL tiw 7 JP.~J ~1.1L'1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Mori -4- 01/25/2007 F BAKERSFIELD PATHOLOGY MED GROUP SiteID: 015-021-0024078 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 10/05/20076 ~ CALL 911 TO CONTACT BAKERSFIELD FIRE DEPT HAZ MATERIALS RESPONSE TEAM. NOTIFY THE SAFETY OFFICER DR JACOBS 201-3648 OR 589-2615 IMMEDIATELY. THE SAFETY OFFICER WILL BE RESPONSIBLE TO COMPLETE STEPS 3 OR 4, AS NECESSARY. CONTACT OFFICE OF ENVIRONMENTAL SERVICES 800-852-7550 TO REPORT ANY SPILLS THAT ARE A THREAT TO LIFE, SAFETY, OR THE ENVIRONMENT. CONTACT OES 326-3979 TO REPORT ANY OTHER SPILLS (NON-EMERGENCY). IF FOR ANY REASON YOU CANNOT CONTACT DR JACOBS THEN CONTACT DR MIRANDA 201-8844 OR 871-6383. r,lllYlVyCC 1VU1.11. / ~VdC:udL1Vi1 _ ""' ~.~~~ Tim ~,rn,6er 1 ~.n~f Sh-e-~7~m gal ~,~h ~--eua~~~~~ x~~: C nc~ em p/D y-e ~ -F~ ~ ~ .sa-~e-. ~cu ~ ~~ cell i 6~ no~-F Q~~ O~~p~' ~~ . ,~ ruuii.~: ivv~ii . ~ ~va~ucit,lvii -~ r ~ ~~ro~-rr- Sfi~--F-~' ~,--v cal-~'~s u s l ~`s-i-~eol ~b ~ v ~ ~y~,.~~s Cc n of G./ ~e~ , Emergency Medical Plan 10/05/206 EMPLOYEES HAVE BEEN INSTRUCTED TO CONTACT 911 IN THE EVENT OF ANY MEDICAL EMERGENCY. THE CLOSEST MEDICAL FACILITY IS SAN JOAQUIN HOSPITAL, 27TH ST BETWEEN H ST & CHESTER AVE. ~' -5- O1/25/~007 F BAKERSFIELD PATHOLOGY MED GROUP SiteID: 015-021-002408 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 10/05/2006 ~ A HAZARD ASSESSMENT HAS BEEN PERFORMED AND PREVENTION MEASURES ARE IN PLACE. A FLAMMABLE CABINET IS AVAILABLE FOR APPROPRIATE STORAGE OF FLAMMABLES AND AN ACID LOCKER IS AVAILABLE FOR APPROPRIATE STORAGE OF ACIDS. FIRE EXTINGUISHERS ARE LOCATED IN THE OFFICE AND IN AREAS WHERE CHEMICALS ARE USED. SAFETY EQUIPMENT (PERSONAL PROTECTIVE EQUIPMENT, SPILL KITS, ETC.) ~S LOCATED ON THE PREMISE. A LIST DESCRIBING SEGREGATION OF CHEMICALS IS AVAILABLE AND USED IN TRAINING. PROCEDURES ARE IN PLACE AND ALL EMPLOYEES ARE TRAINED ACCORDING TO OSHA REQUIREMENTS. Release Containment 10/05/2006 SPILL PIGS ARE AVAILABLE TO CONTAIN SPILLS AND ABSORBENT MATERIAL IS ALSO AVAILABLE IF NEEDED. EMPLOYEES HAVE BEEN INSTRUCTED IN THE USE OF THESE PRODUCTS, BUT ONLY IF THE SPILL IS LIMITED IN AMOUNT. IF THE SPILL IS IN ANY WAY A THREAT TO LIFE, SAFETY, OR HARMFUL TO THE ENVIRONMENT THEN ALL EMPLOYEES HAVE BEEN INSTRUCTED TO CALL 911. Clean Up 10/05/2006 CLEAN HARBORS IS THE VENDOR USED TO REMOVE HAZARDOUS WASTE. ARRANGEMENTS HAVE BEEN MADE FOR REMOVAL ON A MONTHLY BASIS. ALL DISPOSAL RECEIPTS ARE KEPT ON THE PREMISE FOR A PERIOD OF THREE YEARS. SHUTS-OFFS FOR ELECTRICAL AND GAS ARE LOCATED TO THE REAR OF THE BUILDING (SEE SITE DIAGRAM). A LOC!{ BOX WILL BE PURCHASED AND INSTALLED (LOCATION TO BE SPECIFIED BY THE FIRE DEPT INSPECTOR). THE CLOSEST FIRE HYDRANT IS LOCATED NEAR 2901 H ST WHICH IS ACROSS THE STREET AND APPROXIMATELY ONE-HALF BLOCK NORTH OF BAKERSFIELD PATHOLOGY MEDICAL GROUP, 2828 H ST. FIRE EXTINGUISHERS ARE IN THE HISTOLOGY SECTIONS AND IN THE FRONT HALLWAY INSIDE ON THE WALL TO THE RIGHT (SEE V1.11CL 1CCSVUI.LC HLl.1Vdl.lUil -6- 01/25/2007 ;!- , F BAKERSFIELD PATHOLOGY MED GROUP SiteID: 015-021-00240$ ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~peciai ndzaras Utility Shut-Offs ~~~~ ~n . j~'e~~ t.+/ a no~ .~ ~ ate' rl ea-r' r~~ ~-~. r = D1LC YI VI.CU.~tiVd11 WdI.CI ~~ ~NGI~-~~ ~~ lam. F r~ ~x ~i n.9 `s h~-f's ~~ ~~ Sa- `~rd~t9lt ~ ~~/ides. ,, -~`r~~~~ , ~ one. e_ a yam; Building Occupancy Level 05/11/2005 ~ EMPLOYEES ~~ -7- 01/25/2007 a .. F BAKERSFIELD PATHOLOGY MED GROUP SiteID: 015-021-002408 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 10/05/20175 ~ MSDS ARE LOCATED IN A BINDER IN THE CYTOLOGY ROOM (LISTED BY MANUFACTURER). BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES HAVE RECEIVED TRAINING REGARDING REGULATIONS THAT APPLY TO MANAGEMENT OF HAZARDOUS MATERIALS AND WASTE, METHODS TO ENSURE COMPLIANCE, AND PROPER MEANS OF DISPOSAL. TOPICS INCLUDE: DEFINITIONS OF HAZARDOUS MATERIALS, HAZARDOUS WASTE, BIO-HAZARDOUS WASTE; CLASSIFICATIONS AND LISTED WASTES; PROPER USE, HANDLING, STORAGE, AND DISPOSAL METHODS; EMERGENCY PROCEDURES AND PPE; PREPAREDNESS AND PREVENTION; CONTINGENCY PLANS; USE OF MATERIAL SAFETY DATA SHEETS AND DOCUMENTATION (PERMITS, MANIFESTS, INCIDENT REPORTS, INSPECTION RECORDS). rayc c. nc.~la iv.~ ru~uic V5C nC111 LVL ru~u.LC use -8- Ol/25/~007 -• Bakersfield Fire Dept. UNIFIED PROGRAl1A INSPECTION CHECKLIST ~ Eniron>rnental Services >~ ~ -~ , .. _ - _. r, 1715 Chester Ave SECTION 1 Business Plan and Inventory Program ~ Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME s/~o /o b "3[~ PHONE No. No. of Employees ____ 33C-®6ot_a __ (y Business ID Number 15-021-oa a~Eog FACILITYCONTACT Section 1: Business Plan and Inventory Program outine ^ Combined O Joint Agency ^hulti-Agency ^ Complaint ^ Re-inspection .] C/~V IV=Vioationnce~ OPERATION COMMENTS L'7 ^ APPROPRIATE PERMIT ON HAND -.. - ^ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE I~ ---------- -------- ---- ---- ------ --..._---- _ --- -- --- - - _'t --- -- ~ ---__ L4i ^ VISIBLE ADDRESS ~~ IJ ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL (J ^ VERIFICATION OF MSDS AVAILABILITVE ^ VERIFICATION OF HAT MAT TRAINING ,,- - ..-...- ------ - - -- -__ --- _.- - _... ---- --- ~ ~ ~ ~ ~~Q6 LW ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES E~~~ 1~ti ^ EMERGENCY PROCEDURES ADEQUATE LK ^ CONTAINERS PROPERLY LABELED ~^ HOUSEKEEPING -- ------- -- --------------------- -------- ----,t_...- ------ ----- ---- __- _... - -- - - --..-..__ - ------- ------------ LJ ^ FIRE PROTECTION L~7 ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE: YES ^ NO EXPLAIN: ter' s~ ~ e~ . ~~1~ ~ P~ ~ ~____t ~~ce-t~S~C- ~o~C-~y.C~~ P~yI~~.. • QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT ~66 ~ ~ 326-3979 1Al i l1i (t~Vh -~ ~o_~ ~ ~ Inspector (Please Print) Fire Prevention 1st-In/Shift of Site White -Environmental Services Yellow -Station Copy ~~~,~ - -~''C'~--- - Business Site Re onsib a Party (Please Print) g Pink -Business Copy ~~ - - - ,.-~ .. r., .. .. «. .~vv--=,..',. -,.z~l :~ ___ ..;a-Y^4- _~'•-^ t. .. .h-•.., ,.a ~ ~~..-c.N.,~ r -. .-'......~.-....yi a'„~~f j-...L'L:. ~,.. t Bakersfield Fire Dept. IJNIFIE® PROGRAM INSPECTION CHECKLIST / w Enironmental Services ~ - _ _ 4 ~ _ . _ - ~ 1.715 Chester Ave . SECTION 1 Business Plan and Inventory Program sakersfield, cA 93301 Tel: (661)326-3979 FACILITY NAME INSPECTION DATE INSPECTION TIME ADDRESS PHONE No. No. of Employees FACILITYCONTACT Business ID Number .=~ 02. ,n (~"a ~-~~ ~ 15-021- C~~J a ~IC1~` V `Section 1: Business Plan and Inventory Program, ~outine ^ Combined ^ Joint Agency ^Mutti-Agency ~ Complaint ^ Re-inspection V C nce l OPERATION ~ ti C011AMENTS J on V=V o a ' L4 ^ APPROPRIATE PERMIT ON HAND ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE l~ ^ VISIBLE ADDRESS ^' "~ ^ CORRECT OCCUPANCY ®~ ^ VERIFICATION OF INVENTORY MATERIALS ®~ ^ VERIFICATION OF QUANTITIES L"/ ^ VERIFICATION OF LOCATION _- ^ ~ -- -- - -- PROPER SEGREGATION OF MATERIAL -.._ .---------------- -------- --------------- - -- _._ .-- 1 .._.__Clr~-m.vlr~s.:5i~~<__ { ,,_. ..c~.v°_~1__-~aLf'Ua kv~___ _~ .; 1e+~..~_y- ~ / L! ^ VERIFICATION OF MSDS AVAILABILITYE Ly" ^ VERIFICATION OF HA7 MAT TRAINING ^ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES LJ ^ EMERGENCY PROCEDURES ADEQUATE ^ O' CONTAINERS PROPERLY LABELED - - ~ - - r ~' t ~~' ~fJ" ~ - -- I `'"' '` ° r ~ ~~~ ^ ~" HOUSEKEEPING -- - ---- ---- -- -- °-~ 4-.__ LN' ^ FIRE PROTECTION ~ J ^''~^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE: a'YES ^ NO EXPLAIN: /.c%siC. /-t t r;:-~~.n ~ ~~.~ <'1 f a ,r• s i P Val ~~ y1 P ~l QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT t66~ ~ 3ZB-3979 Inspector (Please Print) Fire Prevention tst-In/Shift of Site Business'Site Responyitile Party (Please Print) B N White -Environmental Services Yellow -Station Copy Pink -Business Copy ~ _,.~, . r + BAKERSFIELD PATHOLOGY MED~GROUP _____________________ SiteID: 015-021-002408 + Manager BusPhone: (661) 336-0622 Location: 2828 H ST D Map 102 CommHaz High City BAKERSFIELD Grid: 24C FacUnits: 1 AOV: CommCode: BFD STA Ol SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title STEVEN FOGEL / PATHOLOGIST L GUINTO-MIRANDA / PATHOLOGIST Business Phone: (661) 33~6~-0622x Phone: (661) 871-6383x 24-Hour Phone (661) 201.-3648x 24-Hour Phone (661) ~''~'~^''_=.~~~"qq Pager Phone e e e ~.; ~ `~'J. - o o m ~~ Pager Phone ( 5~-1-? ?~1-° 9~?~? $ x Hazmat Hazards: Fire ImmHlth DelHlth Contact Phone: (661) 336-0622x MailAddr: 2828 H ST D State: CA City BAKERSFIELD. Zip 93301 Owner MIRANDA JACOBS F'OGEL MDS Phone: (661) 336-0622x Address 2828 H ST D State: CA City BAKERSFIELD Zip : 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ PROG A - HAZMAT ENr~~p~~82 oos 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. ~~ r C./ C~e~ w Signature Date -1- 02/27/2006 ` r.. + BAKERSFIELD PATHOLOGY MED~GROUP _____________________ SiteID: 015-021-002408 + += Inventory Item 0003 _______________ Facility Unit: Fixed Containers at Site + +_= COMMON NAME / CHEMICAL NAME ______________________________+________________+ FORMALDEHYDE Days On Site 365 Location within this Facility Unit Map: Grid: +----------------+ CAS# 50-00-0 += STATE _+= TYPE ___+_= PREISSURE ___+ TEMPERATURE __+___= CONTAINER TYPE _____+ Liquid I Mixture I Ambient ~ Ambient I PLASTIC CONTAINER +__________________________+ AMOUNTS AT THIS LOCATION =________________________+ Largest Container I D ily Maximum I D ily Average ~...A~9- GAL ; •~~ -~-9~-6~0 GAL ~ ~ -~3-~9~@--9~A- GAL L---- +_______+______________ HAZARDOUS COMPONENTS =_____________+___+_______________+ %Wt. RS CAS# 37.00 Formaldehyde (EPA Yes 50000 14.00 Methanol No 67561 +_______+___+______+_______=__= HAZARD ASSESSMENTS =__+_________+________+_____+ ITSNOretINoSIBNo azl RNdo~oactive/Cu~ies EPA HaIHrDH I %F~A/ I USDOT# I HiP += Inventory Item 0004 _______________ Facility Unit: Fixed Containers at Site + +_= COMMON NAME / CHEMICAL NAME ______________________________+________________+ ALCOHOL Days On Site 365 Location within this Facility Unit Map: Grid: +----------------+ ~ CAS# ~ += STATE _+= TYPE ___+_= P~E~SSURE ___+ TEMPERATURE __+___= CONTAINER TYPE _____+ Pure ~ ~ ~ PLASTIC CONTAINER ------------------------ +__________________________+ AMOUNTS AT THIS LOCATION =________________________+ Lar est Container Q~ Daily Maximum Q~ Daily Average ------ ~~'---~-o~-GAL-_ I _ V O • -- GAL I U ~ . GAL +_______+______________ HAZARDOUS COMPONENTS =_____________+___+_______________+ 100t00lIsopropyl Alcohol INoSI CAS# 676301 +_______+___+______+__________= HAZARD ASSESSMENTS =__+_________+________+_____+ ITSNoretlNoSIBNoHazl RNo~oac'tive/Curies I EPA Hazards I jF~A/ USDOT# Mod -4- 02/27/2006 ~•. ,... ---< + BAKERSFIELD PATHOLOGY MED'~GROUP _____________________ SiteID: 015-021-002408 + += Inventory Item 0002 =__---__-______= Facility Unit: Fixed Containers at Site + +_= COMMON NAME / CHEMICAL NAME ______________________________+________________+ XYLENE ( Days365 Site Location within this Facility Unit Map: Grid: +----------------+ CAS# 1330207 += STATE _+= TYPE ___+_= PRESSURE ___+ TEMPERATURE __+___= CONTAINER TYPE _____+ Liquid ~ Mixture ~ Ambi.ent ~ Ambient ~ DRUM/BARREL-METALLIC +__________________________+ AMOUNTS AT THIS LOCATION =__________________-_____+ Largest Container I Daily Maximum I Daily Average 3~-6~"'@'6• GAL ~6-6'0 GAL l~ 3~'6~@- GAL +_______+______________ HAZARDOUS COMPONENTS =_____________+___+_______________+ oWt. 77.00 Xylene, Mixed 20.00 Ethylbenzene RS CAS# No 1330207 No 100414 +_______+___+______+_______'___= HAZARD ASSESSMENTS =__+_________+________+_____+ ITSlecoretlNoSIBN Hazl RNod~oactive/Cu~ies I FPA HaIHrDH I /F~A/ I USDOT# I Mod -5- 02/27/2006