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HomeMy WebLinkAboutBUSINESS PLAN 3/14/2007i ip NAPD _ i 4032 JEVVETT AVENUE ~. r - -- ~. . r J ~ ~ r., m ' ~~ B E R S F I L D v FIR.L~~PREVENTION INSPECTION F,RE - ~'` ARTM T -- . _ EAKERSFIELD FIRE DEPT. ~(,~ Prevention Services ~ f _~ 900 Truxtun Ave., Ste. 210 Bakersfield,. CA 93301 ~~ Tel.: (661) 326-3979 ^ Fax: (66;1) 2-2171 ~~,~ DISTRICT BLOCK NO. DATE ~ ~ ~ ~, EE ~c~'"~ • - FACILITY ADDRESS ~ ~' ~ ` t V CITY, ST7CTE, ZIP FACILITY NAME ,~/'~~) -~q6°'~, y'~'+~ ~ t~..! 4.+1 A..I(~~ f ~"'i .c' /~ ixK~ MANAGER'S NAME ,~~// FACILITY PHONE NO~~ - i~~ ('3_.F ) R ~,/~ V~ ~ d Gt ~,~ " r..-~ ~ ! BUSINESS OWNER'S NAME AND ADDRESS ~ ~ )\ CITY, STATE, ZIP ~ ~ ~ OWNER'S PHONE NO. ~ BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, ZIP, BILLING PHONE NO. OCC TYPE OCC LOAD ~ NO. OF FrOORS HIGH RISE BLDG RISE/R DATE ~~ ~ f ~, Q NO / ;Y~ -- ^ YES ` CORRECT ALL VIOLATIONS vio~nrioN REQUIREMENTS CHECKED BELOW no. . COMBUSTIBLE WASTE /DRY 1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.) 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) ExrINGUISHERS 6 Provide and install (amount) _____ approved (type & size) __________________ portable fire extinguisher.to be immediately accessible for use in (area) _____________________________ (U.F.C.) g Re-charge all fire extinguishers. Fire extinguishers shall be serviced at least once each year, andlor after each use, by a person having a valid license or certificate. (U.F.C.) 7 Provide and maintain "EXIT" sign(s) with letters 5 or more inches in height over each required exit (door/window) to SIGNS 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.) g Repair all (cracks/holes/openings) in plaster in (location) ______________________________________. Plastering FIRE DOORS/ FIRE SEPARATIONS Shall return the surface to its original fire resistive condition. (U.B.C.) 10 Remove/repair (item & location) ________________ _ _ _ _ ____ ______ Self-closing doors shall be designed to close by gravity, or by the a ~ r~n~l~e~ by an approved smoke and ~ ` heat sensitive device.. Self-closing doors shall have n ms 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 andlor 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.) 14 Extension cords shall not be used in lieu of permanent approved wiring. Install additional approved electrical outlets ELECTRICAL APPLIANCES ` ~~`~ 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. FIREWORKS 17 Violations of Section 7802 U.F.C. or 8.49.040 of the Bakersfield Munici al Code B.M.C. re ardin fireworks. OTHER 18 ,.,,,,,.. ~ Q~" r l CUSTOMER: `,~~'" "- ~+ ~ ~~~,~~ ~,/p ~~~,~,~ T. LEGEND: ('Sig ature) (Please Print Name Legibly, TItIe) C.F.C. CALIFORNIA FIRE CODE U.B.C. UNIFORM BUILDING CODE /~ INSPECTOR: ~ 'I'`..,....------- AP NO.: / ~ B.M.C. BAKERSFIELD MUNICIPAL CODE N.F.P.A. NATIONAL FIRE PROTECTION ' `(Signature) ._- ASSOCIATION N.E.C. NATIONAL ELECTRIC CODE White -Customer/O~iginal Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09/05) STATE o~cALIFORNU- FIRE SAFETY INSPECTION REQUEST sTD. eso (aEV. ~o-~~ See Instructions on reverse. AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROQRAAA COMMUNITY CARE LICENSING 559 243-8080 2127107 109 EVALUATOR'S NAME REQUEST1Nf3 AGENCY FACILITY NUMBER REQUEST CODE LORI BECK 157203980 1 A CODES RESPONSE REQUIRED ~ r 1. ORKiINAL A. FlRECLEARANCE ucENSING STATE DEPT. OF SOCIAL SERVICES z. RENEWAL B. uFESAFETY AGENCY NAIAEAND .COMMUNITY CARE LICENSING s. cAPACITYCHANGE ADDRESS 770 E. SHAW, SUITE 330 4. OWNERSHIPCHANGE FRESNO, CA 93710-778 s. ADDRESS CHANGE 8. NAME CHANGE 7. OTHER AMBULATORY NONAMBUL/~QRY BEDRIDDEN TOTAL CAPACITY CAPACITY VREVIOUS CAPACITY CAPACITY PP,- 8 CAPACITY CAPACITY RaENWS CAPAdTY 0 0 30 0 0 0 30 FACILITY NAME urxna~ cwr ~~ N.A.P.D. TRANSPORTATION BREAKFAST CLUB ADULT DAY PROGRAM STREET ADDRESS (Astw/ Location) NUMBER OF BUILDINQ8 4032 JEWETT AVENUE 1 CRY _ RESTANNT _ _ BAKERSFIELD, CA 93301 NONE FACIUTYCONfACTPERSON'SNAME ._ .. .._ ........... ..__.. .~. __. ...... . _.. _ .__ .. ___..__.._ _.........._ _.. HDUR8 DAVID SHAWN KENNEMER (661) 322-9735. DAYS sPECULCaNOmoNS .._... BAKERSFIELD FIRE DEPARTMENT ~E ATTN: DAVE WEIRATHER AUTHORITY '''A"EAND 900 TRUXTUN AVE., SUITE 210 A-°-°i~~--~-ff BAKERSFIELD; CA 93301 L.~ wsPECroR~s NAME (Tyyaa a r>,rwa~ TELEPFIOPIE NUMBER l1SPECTION DATE I N~7ECTOR'8 SIGNATURE (Typd a PEA !~ EXPLAIN 06JIAL OR LIST SPECIAL OONDITIONS. , _ _ . _ , _ _ _ cFIRS NUMBER I OCCUPANCY CLA88 1. FIRE CLEARANCE GRANTED 2. FlRE CLEARANCE DENIED . A. EXITS B. OON8TRUCTION C. FlRE ALARM D. SPRINKLERS E. HDUSOCEEPINO F. SPECIAL HAZARD G. OTHER S"~TE ~JF cALCPQ.RR:tA~' FIDE SAFETY INSPECTION REQUEST See Jnstructlons on reverse. sro. eso (REV. tae4) AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM COMMUNITY CARE LICENSING 559 243-8080 2/27/07 109 EVALUATORS NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE LORI BECK 157203980 1 A RESPONSE REQUIRED coDEs i. ORK3INAL A. FlRECLEARANCE LICENSING ~TATE DEPT. OF SOCIAL SERVICES ~ 2. RENEWAL B. LIFE SAFETY AGENCY NAME AND COMMUNITY CARE LICENSING 3. CAPACITYCHANGE ADDRESS 770 E. SHAW, SUITE 330 4. OWNERSHIP CHANGE FRESNO, CA 93710-778 5. ADDRESS CHANGE 6. NAME CHANGE 7. OTHER CAPACITY 0 =ACILTTY NAME N.A.P.D. TRAN )RTATION BREAKFAST CLUB BEDRIDDEN cAPaclrY PR~ous CAPAgTY 0 0 TOTAL CAPACITY 30 _ __' LICENSE C'ATEl30RY ADULT DAY PROGRAM STREET ADDRESS (AUUat Location) NUMSER OF BUILDINGS 4032 JEWETT AVENUE 1 CITY RESTRAINT BAKERSFIELD, CA 93301 NONE FACILITY CONTACT PERSON'S NAME HOURS DAVID SHAWN KENNEMER (661) 322-9735 DAYS sPECaL coNDmoNs BAKERSFIELD FIRE DEPARTMENT ARE ATTN: DAVE WEIRATHER AUTHORITY NAMEAND Ir'~00 TRUXTUN AVE., SUITE J ~~~ ADDRESS BAKERSFIELD, CA 93301 ECTORB NAME a P~i7N~ TELEPHONE NUMSER CFIRS NUMSER ECTION DATE INSPECTORS yPW or -~~ n7 ~ ,rte ~~ wAL c~oa CODES t,~IRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. Exlrs B. CONSTRUCTION C. FlRE ALARM Cues ~n,--8P!?!NKI:l:R:4-_--- -.__ ~~ F. SPECIAL HAZARD G. OTHER AMBULATORY NONAMBULATORY PREVgUS CAPACRY CAPACITY PREVIOUS C 0 30 0 :e- ******,,~iP MFP Digital Sending: Delivery Confirmation ****** The following job has been successfully delivered to the specified recipient(s) and/or intermediate server. ---------------- Original message header ------------------ From: BFD HazMat 900 Truxtun - 10.1.32.55 Date: Tuesday, March 20, 2007 2:04:48 PM Subject: --------------------- Recipient List---------------------- 16349638 [successful transmission] ,v.,:. ., ~•~ **~'***-.HP MFP Digital Sending: Delivery Confirmation ****** The following job has been successfully delivered to the specified recipient(s) and/or intermediate server. ---------------- Original message header ------------------ From: BFD HazMat 900 Truxtun - 10.1.32.55 Date: Monday, March 19, 2007 1:34:07 PM Subject --------------------- Recipient List ---------------------- 3271452 [successful transmission] NAPD SiteID: 015-021-000256 Manager SILSO GANTONG Location: 4032 JEWETT AVE City BAKERSFIELD BusPhone: (661) 395-1361 Map 103 CommHaz Low Grid: 19A FacUnits: 1 AOV: CommCode: KCFD STA 64 EPA Numb: SIC Code:8331 DunnBrad:08-218-5679 Emergency Contact / Title Emergency Contact / Title CHRISTINE BEEBOUT / HEALTH/SAFE DIR CHRIS BEEBOUT / TRANSPORTATION Business Phone: (661) 395-136 1x Business Phone: (661) 322-6542x 24-Hour Phone (661) 706-723 0x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire DelHlth Contact CHRISTINE BEEBOUT Phone: (661) 395-1361x MailAddr: 2601 F ST State: CA City BAKERSFIELD Zip 93301 Owner NEW ADVANCES/PEOPLE W/DISABILITIE Phone: (661) 395-1361x Address 2601 F ST State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif' d: RSs : No ParcelNo: Emergency Directives: PROD A - HAZMAT ~ PROG H - PROG T - l~ HAZ WASTE GEN JV ~ ABOVEGROUND STORAGE TANK 3 ~DO7 [3aved an my inguiry of thaw indivic;uais reSpC?nui~;e fi}r olatcllning thF infOrm~tiC~n, 1 C:~rtl7y under penalty of laud that 1 have personafiy examined and am familiar with the information submitted and belie;!e the information is true, accurate, and'' c//,,omp~ete. ~ [ "~] Signature Date -1- 07/12/2007 d F NAPD SiteID: 015-021-000256 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE OIL F DH L 200.00 GAL Low WASTE ANTIFREEZE F DH IL 55.00 GAL Low MOTOR OIL F DH L 55.00 GAL Min LUBE GREASE F DH L 30.00 GAL Min WASTE OIL FILTERS F DH S 55.00 GAL UnR -2- 07/12/2007 -3- 07/12/2007 F NAPD SitelD: 015-021-000256 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE OIL Days On Site 365 Location within this Facility Unit Map: Grid: NE SHOP CAS# I 1221 Liquid Twaste -TAmbRent~E ~AmbientT~E ABOVEOGROIINDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 GAL 200.00 GAL 70.00 GAL - HAZARDOUS COMPONENTS °~Wt. RS CAS# 100.00 Waste Oil, Petroleum Based No 0 t11-1GE1KL Ei. 7.71;.7.71~1L' 1V l ~J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE ANTIFREEZE Days On Site 365 Location within this Facility Unit Map: Grid: NE STORAGE RM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Twaste ~ Ambient ~ Ambient .DRUM/BARREL-METALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 15.00 GAL ns~GS~tu~vu~ wl~irvlv~ly l oWt. RS CAS# 100.00 Ethylene Glycol No 107211 - - riLiGl-~KL 1-L 7.7J;.7J1~1L" 1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / j Low -4- 07/12/2007 F NAPD ~ Inventory Item 0003 COMMON NAME / CHEMICAL NAME MOTOR OIL Location within this Facility Unit NE STORAGE RM STATE TYPE PRESSURE Liquid TMixture ~mbient SiteID: 015-021-000256 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 8020835 TEMPERATURE CONTAINER TYPE Ambient DRUM/BARREL-METALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 55.00 GAL 55.00 GAL 28.00 GAL nEiGHKLVUJ wlnrvlvl,ly-1J %Wt. RS CAS# 100.00 Motor Oil, Petroleum Based No 8020835 riHGHKL HJ J~JJ1~11;1V-1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Min ~ Inventory Item 0004 COMMON NAME / CHEMICAL NAME LUBE GREASE Location within this Facility Unit NE STORAGE RM STATE - TYPE PRESSURE Liquid Mixture ~mbient Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 8020835 TEMPERATURE CONTAINER TYPE Ambient DRUM/BARREL-METALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 30.00 GAL 30.00 GAL 20.00 GAL 1~-,ZARDOUS COMPONENTS oWt• RS CAS# 100.00 Heavy Machine Oil No 8020835 riL'iGL'i.RL tiJ JP~JJ1"11'.~1V 1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Min -5- 07/12/2007 F NAPD ~ Inventory Item 0005 COMMON NAME / CHEMICAL NAME WASTE OIL FILTERS Location within this Facility Unit SHOP STATE TYPE PRESSURE Solid TWasteAmbient SiteID: 015-021-000256 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# TEMPERATURE CONTAINER TYPE _ Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 55.00 GAL riAGL~KLVU~ 1:v1~1r~1vLlv~1~~ %Wt. RS CAS# MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No tll-~GHKL E3J.7L" ~J.71~1~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / UnR -6- 07/12/2007 F NAPD SiteID: 015-021-000256 Fast Format ~ Notif./Evacuation/Medical Overall Site Agency Notification 04/28/2006 C~~ ~~~ THE DISPATCHER NOTIFIE WHO NOTIFIES THE EXECUTIVE DIRECTOR AND/OR DEPARTMENT DIRECTOR, AND ALSO NOTIFIES 911. 9 Employee Notif./Evacuation 03/01/2000 PA SYSTEM AND FIRE ALARM. Public Notif./Evacuation 04/28/2006 SOME ADMINISTRATIVE PERSONNEL WOULD BE ABLE TO ASSIST THE FIRE DEPT OR OTHER RESPONDING EMERGENCY CREWS. HOWEVER, DUE TO THE FACT THAT WE ARE A LICENSE CARE FACILITY, DIRECT CARE STAFF MUST REMAIN WITH OUR CLIENTS TO ENSURE THEIR SAFETY. Emergency Medical Plan 04/28/2006 ALL PERSONNEL ARE TRAINED IN FIRST AID, CPR, AND 911 NOTIFICATION. HAZARDOUS MATERIALS EXPOSURE: MEDI CENTER FOR MINOR ACCIDENTS AND MEMORIAL HOSPITAL FOR ANYTHING MORE SERIOUS. -7- 07/12/2007 F NAPD SiteID: 015-021-000256 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 04/28/2006 ~ ALL FLANIMABLES ARE IN METAL CABINETS IN A LOCKED STORAGE ROOM IN THE ORIGINAL CONTAINERS. NEW MOTOR OIL, ANTIFREEZE, AND USED OIL FILTERS ARE STORED IN APPROVED 55-GAL DRUMS. WASTE OIL IS STORED IN AN ABOVEGROUND STORAGE TANK. LUBE GREASE IS IN AN APPROVED 30-GAL STORAGE DRUM. Release Containment 04/28/2006 LIMIT AMOUNT OF MATERIALS KEPT ON LOCATION. LIMIT NUMBER OF STAFF WORKING AROUND HAZARDOUS MATERIALS. DAILY CHECK OF CONTAINERS TO ENSURE NO LEAKAGE. Clean Up 04/28/2006 FOR SMALL LEAKS, THE COMPANY THAT OWNS THE DRUM WOULD BE IMMEDIATELY NOTIFIED SO THEY MAY PICK UP AND REPLACE DRUM. SMALL LEAKS WOULD BE CLEANED WITH SHOP TOWELS AND KWIK SORB. SOURCE OF LEAK WOULD BE ELIMINATED. LARGE SPILLS WOULD BE CONFINED WITH KWIK SORB WHILE THE HAZARDOUS MATERIALS RESPONSE TEAM WAS NOTIFIED THROUGH 911. Vl.i1Ct ,RCw'~V UL I:C til:L1VCLL1V11 -8- 07/12/2007 F NAPD SiteID: 015-021-000256 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ orrc~.l.ai na~uiu5 Utility Shut-Offs 02/05/2007 A) GAS - OUTSIDE SE CRNR GARAGE MAIN OUTSIDE NW CRNR OFFICE B) ELECTRICAL - OUTSIDE SE CRNR OFFICE C) WATER - OUTSIDE SE CRNR GARAGE MAIN W OF OFFICE NEAR ST D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 12/29/2006 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - SW CRNR OF PARKING LOT NEAR DRIVEWAY. Building Occupancy Level 04/28/2006 60 EMPLOYEES -9- 07/12/2007 F NAPD SiteID: 015-021-000256 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 04/28/2006 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: NEW EMPLOYEES GO THROUGH ORIENTATION WITH THE STAFF TRAINING COORDINATOR. CONTINUING SAFETY TRAINING IS DONE THROUGH REGULAR STAFF TRAINING/SAFETY MEETINGS. IN ADDITION, BANNERS AND POSTERS ARE USED TO STRESS SAFETY. TRAINING FLIERS ARE ISSUED AS FOLLOW-UP TO TRAINING. rc-yc a Held for Future Use nciu tvi rut,utc vac -10- 07/12/2007 NAPD SiteID: 015-021-000256 Manager ~t ~~ Ca,~Ct~ti Location: 4032 JEWETT AVE~ City BAKERSFIELD BusPhone: (661) 395-1361 Map 103 CommHaz Low Grid: 19A FacUnits: 1 AOV: CommCode: KCFD STA 64 EPA Numb: SIC Code:8331 DunnBrad:08-218-5679 Emergency Contact / Title Emergency Contact / Title ~p~ / HEALTH/SAFE DIR ~ ~- CHRIS BEEBOUT / TRANSPORTATION 661) 395-1361x Business ?Iio e Business Phone: (661) 322-6542x 24 -Hour Phone ( 661) °'" =" ^ °y']61p ~ 24 -Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire DelHlth Contact C ul'Q~~'tV1~ `~j~2~jD[TT' J Phone : ( 661) 3 95 =13 61x _ _ , MailAddr: 2601 F ST State: CA City BAKERSFIELD Zip 93301 Owner NEW ADVANCES/PEOPLE W/DISABILITIE Phone: (661) 395-1361x Address 2601 F ST State: CA City BAKERSFIELD Zip 93301_ Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG T - ABOVEGROUND STORAGE TANK Faced on my inquiry of thou indl~il~licli3 r-espot~~,;;!p fc~r rshtalrtir5~ thy: irift7rr~at'son, I certify under penalty ©f law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. ~ ~ /~ L ~!° _ b 7 , Signature Date ~~~~ ~"` ~ ~ ~ ~t ~UU7 -1- 02/05/2007 F NAPD SiteID: 015-021-000256 ~ ~ Hazmat-Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE OIL F DH L 200.00 GAL Low WASTE ANTIFREEZE F DH L 55.00 GAL Low MOTOR OIL F DH L ~ 55.00 GAL Min LUBE GREASE F DH L 30.OO ~GAL Min WASTE OIL FILTERS F DH S 55.00 GAL UnR -2- 02/05/2007 -3- 02/05/2007 2 F NAPD SiteID: 015-021-000256 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE OIL Days On Site 365 Location within this Facility Unit Map: Grid: NE SHOP CAS# 221 Liquid TWaste ~ AmbRent~E ~ AmbientT~E ABOVE GROIUNDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 GAL 200.00 GAL 70.00 GAL tu~GS-utLl7U5 COMPONENTS %Wt. RS CAS# 100.00 Waste Oil, Petroleum Based No 0 tSHGHKIJ Yaw7 w7U" JJ1~lL" 1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE ANTIFREEZE Days On Site 365 Location within this Facility Unit Map: Grid: NE STORAGE RM CAS# Liquid TWaste ~ AmbRent~E ~ AmbientT~E DRUM/BNARRELEMETALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum .Daily Average 55.00 GAL 55.00 GAL 15.00 GAL nr~c~rucLV V a ~.vrirvlv~ly t ~ %Wt. RS CAS# 100.00 Ethylene Glycol No 107211 ruic,r~L tia a~a~iYir,lvi~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low -4- 02/05/2007 t ' F NAPD SiteID: 015-021-000256 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME MOTOR OIL Days On Site 365 Location within this Facility Unit Map: Grid: NE STORAGE RM CAS# 8020835 Liquid TMixtur~ Ambient~E ~ AmbientT~E DRUM/BARRELEMETALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL- 55.00 GAL 28.00 GAL t1HGHtCLVUJ 1;V1~lYV1VL'1V1b %Wt. RS CAS# 100.00 Motor Oil, Petroleum Based No 8020835 t11~GHtCL E~.7 .7L'a~7.71~1L' 1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / j / Min ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME LUBE GREASE Days On Site 365 Location within this Facility Unit Map: Grid: NE STORAGE RM CAS# 8020835 Liquid TYPE PRESSURE TEMPERATURE CONTAINER TYPE TMixtur~ Ambient ~ Ambient DRUM/BARREL-METALLI~ AMOUNTS AT THIS LOCATION Largest Con30100rGAL Daily M30100m GAL I - Daily A20r00e GAL nt,arucLV V ~ ~.viYirvly c,lv t ~ %Wt. RS CAS# 100.00 Heavy Machine Oil No 8020835 I11iGt~tCL HJ J~w7 a1"1P~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Min -5- 02/05/2007 F NAPD SiteID: 015-021-000256 ~ ~ Inventory Item 0005 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE OIL FILTERS Days On Site 365 Location within this Facility Unit Map: Grid: SHOP CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Solid TWaste -~mbient ~ Ambient DRUM/BARREL-METALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 55.00 GAL nra~tatcLVU~ winrulv~;iv~t~5 %Wt. RS CAS# MIXTURE OF WASTE OIL HEAVY PETROLEUM DISTILLAT No riL~GHKL H~ JL' JJ1~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / UnR -6- 02/05/2007 i F NAPD SiteID: 015-021-000256 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 04/28/2006 ~ THE DISPATCHER NOTIFIES LOU LOPEZ WHO NOTIFIES THE EXECUTIVE DIRECTOR AND/OR DEPARTMENT DIRECTOR, AND ALSO NOTIFIES 911. Employee Notif./Evacuation 03/01/2000 PA SYSTEM AND FIRE ALARM. Public Notif./Evacuation 04/28/2006 SOME ADMINISTRATIVE PERSONNEL WOULD BE ABLE TO ASSIST THE FIRE DEPT OR OTHER RESPONDING EMERGENCY CREWS. HOWEVER, DUE TO THE FACT THAT WE ARE A LICENSE CARE FACILITY, DIRECT CARE STAFF MUST REMAIN WITH OUR CLIENTS TO ENSURE THEIR SAFETY. Emergency Medical Plan .04/28/2006 ALL PERSONNEL ARE TRAINED IN FIRST AID, CPR, AND 911 NOTIFICATION. HAZARDOUS MATERIALS EXPOSURE: MEDI CENTER FOR MINOR ACCIDENTS AND MEMORIAL HOSPITAL FOR ANYTHING MORE SERIOUS. -7- 02/05/2007 F NAPD SiteID: 015-021-000256 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention 04/28/2006 ALL FLAMMABLES ARE IN METAL CABINETS IN A LOCKED STORAGE ROOM IN THE ORIGINAL CONTAINERS. NEW MOTOR OIL, ANTIFREEZE, AND USED OIL FILTERS ARE STORED IN APPROVED 55-GAL DRUMS. WASTE OTL IS STORED IN AN ABOVEGROUND STORAGE TANK. LUBE GREASE IS IN AN APPROVED 30-GAL STORAGE DRUM. 9 Release Containment 04/28/2006 LIMIT AMOUNT OF MATERIALS KEPT ON LOCATION. LIMIT NUMBER OF STAFF WORKING AROUND HAZARDOUS MATERIALS. DAILY CHECK OF CONTAINERS TO ENSURE NO LEAKAGE. Clean Up 04/28/2006 FOR SMALL LEAKS, THE COMPANY THAT OWNS THE DRUM WOULD BE IMMEDIATELY NOTIFIED SO THEY MAY PICK UP AND REPLACE DRUM. SMALL LEAKS WOULD BE CLEANED WITH SHOP TOWELS AND KWIK SORB. SOURCE OF LEAK WOULD BE ELIMINATED. LARGE SPILLS WOULD BE CONFINED WITH KWIK SORB WHILE THE HAZARDOUS MATERIALS RESPONSE TEAM WAS NOTIFIED THROUGH 911. ~,_ V ~.11G1 ncovui~c Al.V1VCL 1.1 Vll -8- 02/05/2007 F NAPD SiteID: 015-021-000256 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ J~1CC:ld1 ildGdLU~7' Utility Shut-Offs A) GAS - OUTSIDE SE CRNR GARAGE MAIN OUTSIDE NW CRNR OFFICE B) ELECTRICAL - OUTSIDE SE CRNR OFFICE C) WATER - OUTSIDE SE CRNR GARAGE MAIN W OF OFFICE NEAR ST D) SPECIAL - NONE E) LOCK BOX - NO 02/05/2007 Fire Protec./Avail. Water 12/29/2006 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - SW CRNR OF PARKING LOT NEAR DRIVEWAY. Building Occupancy Level 04/28/2006 60 EMPLOYEES -9- 02/05/2007 F NAPD SiteID: 015-021-000256 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 04/28/2006 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: NEW EMPLOYEES GO THROUGH ORIENTATION WITH THE STAFF TRAINING COORDINATOR. CONTINUING SAFETY TRAINING IS DONE THROUGH REGULAR STAFF TRAINING/SAFETY MEETINGS. IN ADDITION, BANNERS AND POSTERS ARE USED TO STRESS SAFETY. TRAINING FLIERS ARE ISSUED AS FOLLOW-UP TO TRAINING. rayC ~ nciu ivt r u~u.LC v~C nCtu i.vi rul.ule use -10- 02/05/2007 + NAPD ________________________________________________ SiteID: 015-021-000256 + Manager Location: 4032 JEWETT AVE City BAKERSFIELD' BusPhone: (661) 395-1361 Map 103 CommHaz Low Grid: 19A FacUnits: 1 AOV: CommCode: KCFD STA 64 EPA Numb: SIC Code:8331 DunnBrad:08-218-5679 Emergency Contact / Title Emergency Contact / Title LOU LOPEZ / HEALTH/SAFE DIR CHRIS BEEBOUT / TRANSPORTATION Business Phone: (661) 395-1361x Business Phone: (661) 322-6542x 24-Hour Phone (661) 871-2325x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire DelHlth Contact Phone: (661) 395-1361x MailAddr: 2601 F ST State: CA City BAKERSFIELD Zip 93301 Owner NEW ADVANCES FOR PEOPLE W/DISABIL Phone: (661) 395-1361x Address 2601 F ST State: CA City BAKERSFIELD Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG T - ABOVEGROUND STORAGE TANK ENT A PR z ~ 2006 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 s bmitted and believe the in ormation is true, curate, and co plete. ignature Date -1- 03/27/2006