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HomeMy WebLinkAboutBUSINESS PLAN~, _, .. u _. SW FAMILY DENTISTRY ~ - 1601 MILL ROCK WAY ,, '~ SOUTHWEST FAMILY DENTISTRY Anthony G. Ching, DDS General Dentistry 1601 Mill Rock Way Bakersfield, CA 93311 (661}833-0101 SouthwestDentistry@bak.rr.com www.SouthwestDentistrycom UNIFIED PROGRAM INSPECTION CIiECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY AME ~rvorc i ivrv ni c morci. ~ ivrv i nvic `~r~J~ ~ ., C ~t r ~G. (~ Q S 1'7P~ ~~ ~e1~ t1 a."~T'r NtY ~ ~ p 4' ADDRESS PHONE No. No. of Employees FACILITYCONTACT Business ID Number ~ ~! ,~ 1$-021- ~"'l-."' Section 1: Business Plan and Inventory Program 1~2outine ^ Combined ~ Joint Agency ^Mutti-Agency ^ Complaint ^ Re-inspection C' V nce~ OPERATION t lV=Voa on ^ ^ APPROPRIATE PERMIT ON HAND ^ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ ^ VISIBLE ADDRESS ^ ^ CORRECT OCCUPANCY ^ ^ V E ERIFICATION OF INVENTORY MAT ^ ^ VERIFICATION OF QUANTITIES ^ ^ VERIFICATION OF LOCATION ^ ^ PROPER SEGREGATION OF MATERIAL ^ ^ VERIFICATION OF MSDS AVAILABILITYE ^ ^ VERIFICATION OF HAT MAT TRAINING ^ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ ^ EMERGENCY PROCEDURES ADEQUATE ^ ^ CONTAINERS PROPERLY LABELED ^ ^ HOUSEKEEPING ^ ^ FIRE PROTECTION ^ ^ SITE DIAGRAM ADEQUATE 8c ON HAND ANY HAZARD'OUS0~,9W~ASTE ON SITE EXPLAIN:. wY ~ ~~- ~t ~e COMMENTS YES ^ No ~a~ ~~ QUESTIOrN~S REGARDING THIS INSPECTION? PLEASE CALL US AT ~G6'I ~ 328-39~I9 ' 4~ S 3 W Inspector Badge No., White -Environmental Services Yellow - Statbn Copy ---- -- 11'=~~~- Busi s Site Responsible Party Pink • Business Copy ~v ~~ L Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST >z E R s F , 0 900Truxtun Ave., Suite 210 -- _ _ _.:- ~ --FARE Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program ""~r"' r Tel.: (661) 326-3979 ,: ~ Fax: (661) 872-2171 FACILITY NAME /~ INSPECTION DATE INSPEcCTION TIME ADDRESS I M i I I k PHONE NO. ~-S33-e~- o f NO OF EMPLOYEES ~~ FACILITY CONTACT BUSINESS ID NUMBER 15-021- C7o '3 3 ~$ Section 1; Business Plan and Inventory Program ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI=AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ( C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIn@SS 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 ~~ 1 ^ CONTAINERS PROPERLY LABELED 4 ^ HOUSEKEEPING q]~^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND nnr-nuts ANY HAZARDOUS WASTE ON SITE? YES ^ NO EXPLAIN: QUESTIONS REGARDING THI/S INSPECTION? PLEASE CALL US AT (661) 326-3979 ~v~~`? r2 S G, ~ D'IG~~j S ~ I Inspector (Please Print) Fire Prevention / 1~` In /Shift of Site/ tation # White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 4 A SOI~THWE~T FAMILY DENTISTRY SiteID: 015-021-003378 Manager ANTHONY G CHING BusPhone: (661) 833-0101 Location: 1601 MILL ROCK WY Map 123 CommHaz High City BAKERSFIELD Grid: 05D FacUnits: 1 AOV: CommCode: BFD STA 09 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title ANTHONY G CHING DDS / OWNER SANDRA LOPEZ / ADMINISTRATOR Business Phone: (661) 833-OlOlx Business Phone: (661) 833-OlOlx 24-Hour Phone ( ) - x 24-Hour Phone (661) 203-3464x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press React ImmHlth DelHlth Contact ANTHONY G CHING Phone: (661) 833-OlOlx MailAddr: 1601 MILL ROCK WY State: CA City BAKERSFIELD Zip 93311 Owner SOUTHWEST FAMILY DENTISTRY Phone: (661) 833-OlOlx Address 1601 MILL ROCK WY State: CA City BAKERSFIELD Zip 93311 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif' d: RSs : No ParcelNo: Emergency Directives: PROG A - HAZMAT ENT'D ~ UL p~ ~ ~~~~ PROG H - HAZ WASTE GEN F+ PROG T - ABOVEGROUND STORAGE TANK Based on my ina,uiry of those indiwiduais res~cnsib~ia ;~~r ebtai;~ing the informa~ion, I ce,tify under penalty of la~~ trat I h~:ve personally examined and am familiar v~~ith the information submitted and 4aaiieE.~e the information is true, accurate and complete. ~l-~~, ~ignatu~ . Date -1- 07/16/2007 T F SOl'7THWEST FAMILY DENTISTRY SiteID: 015-021-003378 ~ ~ Hazmat Inventory By Facility Unit ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE F P IH G 400.00 FT3 Hi OXYGEN F IH DH G 1000.00 FT3 Low DIESEL L 70.00 GAL Low WASTE FIXER R L 5.00 GAL Min -2- 07/16/2007 ~ )'. .i -3- 07/16/2007 F SO~7THWEST FAMILY DENTISTRY SitelD: 015-021-003378 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME NITROUS OXIDE Days On Site 365 Location within this Facility Unit Map: Grid: GAS STORAGE RM CAS# 10024-97-2 ~GasATE T TYPE PRESSURE TEMPERATURE CONTAINER TYPE I Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 FT3 400.00 FT3 ~ 400.00 FT3 t1E1GEiKLVU~ I:VL~LYVIV~IVIS $Wt. RS CAS# 100.00 Nitrous Oxide No 10024972 t1HGHKL H5J1" J~L~L~1V l TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: GAS STORAGE RM CAS# 7782-44-7 ~GaSATE TYPE ~f PRESSURE TEMPERATURE CONTAINER TYPE TPure I Above Ambient Ambient PORT. PRESS. CYLINDE~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 249.00 FT3 1000.00 FT3 1000.00 FT3 nr~ZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 tiHGHtC1J H~7 ~Jt',.7~L~Lr,1V-1~7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -4- 07/16/2007 F SOUTHWEST FAMILY DENTISTRY SiteID: 015-021-003378 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME DIESEL Days On Site 365 Location within this Facility Unit Map: Grid: EXT GEN ENCL CAS# 70892103 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 70.00 GAL 70.00 GAL 70.00 GAL r1r~ZARDOUS COMPONENTS sWt. RS CAS# 100.00 Fuel Oil No. 1 No 70892103 riAGKKL A5~1"~~51~11"~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Low ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: DARKROOM CAS# Liquid TWaste ~ Ambient~E ~ AmbientT~E ~LASTOICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL t]t~GL'itCLVUA 1.V1~lYV1VL'1V1J sWt. RS CAS# Silver No 7440224 ru~c~hrcL t~a~r~~~l~i~ty t a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -5- 07/16/2007 S. ~ ~ F SOUTHWEST FAMILY DENTISTRY SiteID: 015-021-003378 ~ Fast Format ~ ~;Notif./Evacuation/Medical Overall Site ~ agency rvoziticaLic~n Employee Notif./Evacuation Public Notif./Evacuation L'lllG1~G11Vy 1'1r.U1trQ1 r1Gi11 -6- 07/16/2007 F SOUTHWEST FAMILY DENTISTRY SiteID: 015-021-003378 ~ Fast Format ~ ,Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention - iCC1CQw7C 1..V11LQ111lllCll 1. 1..1 CCLll IJ~J ~,_ V l.i1Gt L1C.7VlAl VC 1"11. 1..1V0.1.1 V11 -7- 07/16/2007 J' ,' F SOIJTH_WEST FAMILY DENTISTRY SiteID: 015-021-003378 ~ Fast Format ~ ;Site Emergency Factors Overall Site ~ .7 LJCC:1d1 17d'Gdl_ C.LS V 1.1111.Y J11U 1.-V11.`7" ~. ~ 1" 1LG r1Vl..CV / 17V q.11 . YY 0.l.Gt DU11U1111~. VC:L l1~JdilC: ~/ LCVC1 -8- 07/16/2007 .~ ~ F SOtJ'I'HWEST FAMILY DENTISTRY SiteID: 015-021-003378 ~ Fast Format ~ ,Training Overall Site ~ ~mpioyee lrainiuy rays ~ aaciu ivt i• u~.utc vac Held for Future Use -9- 07/16/2007 ~~ aF.SOUTHWEST FAMILY DENTISTRY Manager Location: 1601 MILL ROCK WY City BAKERSFIELD CommCode: BFD STA 09 EPA Numb: ~,: 1 BusPhone: Map 123 Grid: 05D SiteID: 015-021-003378 (661) 833-0101 CommHaz High FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title ANTHONY G CHING DDS / OWNER ~3ot~t,Gol~'a. Lo~~•z- / ~1Om,«.G-s ~/'a~~°~ Business Phone: (661) 833-OlOlx Business Phone: (~~f )~~3 -oioi x Zl~ 24-Hour Phone ( ) - x 24-Hour Phone (~G~f )~~'3 - 3~F~yx Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press React ImmHlth DelHlth Contact ANTHONY G CHING DDS Phone: (661) 833-0101x MailAddr: 1601 MILL ROCK WY State: CA City BAKERSFIELD Zip 93311 Owner SOUTHWEST FAMILY DENTISTRY Phone: (661) 833-0101x Address 1601 MILL ROCK WY State: CA City BAKERSFIELD Zip :, 93311: .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 [3ased on my inquiry of those individuals r obtaornng the information, 1 certify f l o e responsib under penalty of Ia~rJ that I have personally examined and am familiar with the information true i ~ ENT'D F E B 6 7 2~p , s submitted and believe the information / and complete. accurate , `~i.4~/~-G~- Date. nature Si g -1- 02/06/2007 :F SOUTHWEST FAMILY DENTISTRY SiteID: 015-021-003378 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm ,DailyMax Unit MCP NITROUS OXIDE F P IH G 400.00 FT3 Hi OXYGEN F IH DH G 1000.00 FT3 Low DIESEL L 70.00 GAL Low WASTE FIXER R L 5.00 GAL Min -2- 02/06/2007 -3- 02/06/2007 ;F SOUTHWEST FAMILY DENTISTRY SiteID: 015-021-003378 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME NITROUS OXIDE Days On Site 365 Location within this Facility Unit Map: Grid: GAS STORAGE RM CAS# 10024-97-2 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Ambient FORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 FT3 400.00 FT3 400.00 FT3 _. _.. __.._ TTT ATT1T1l1TTA /Tf1~RT\l~1TTTTTTA I3EiGL-1[CLV V J ~.V1T1rVlvaty t J °sWt. RS CAS# 100.00 Nitrous Oxide No 10024972 t1HGHKL 1~J Jr,JJ1~1J;1V 1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: GAS STORAGE RM CAS# 7782-44-7 ~GasATE TYPE PRESSURE ~ TAE~MPeRATURE ~ CONTAINER TYPE TPure Above Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 249.00 FT3 1000.00. FT3 1000.00 FT3 i1L-1G1'iLCLVVJ ~.VP'lYV1Vr,1V1.7 ~Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 l1HGHtCL EiJ.71;JJL~1.C~1V1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -4- 02/06/2007 ;F SOUTHWEST FAMILY DENTISTRY ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME DIESEL Location within this Facility Unit EXT GEN ENCL STATE TYPE PRESSURE Liquid TMixture ~-Ambient SiteID: 015-021-003378 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 70892103 TEMPERATURE CONTAINER TYPE Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 70.00 GAL 70.00 GAL 70.00 GAL - riHGLjt'CLVU7 1.V1~lYV1VL'1V17 cwt. Rs cAS# 100.00 Fuel Oil No. 1 No 70892103 riHGHKL A~ 7L7a1Y1t51V1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Low ~ Inventory Item 0004 COMMON NAME / CHEMICAL NAME WASTE FIXER Location within this Facility Unit DARKROOM Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# Liquid TWaste ~AmbRent~E ~ AmbientT~E ~ PLASTOICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum 5.00 GAL 5.00 GAL Daily Average 5.00 GAL ru~c~tu~LVU~ ~.V1~1rVivr.ivl5 %Wt. ~ RS CAS# Silver No 7440224 IIHGHCtL HJ .7~.7.71~1~1V-1 w7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -5- 02/06/2007 :F SOUTHWEST FAMILY DENTISTRY SitelD: 015-021-003378 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification w / .-. P~LIL~J1VyCC 1VV 1.11. ~ GV0.1. lAdLlVll i.-. t U1J1ll.: 1VV 1..11. ~ P~V0.VU0.L1Vll PrlllClt~. Clll:Y 1"1C U11:d1 Y1d11 -6- 02/06/2007 ~F SOUTHWEST FAMILY DENTISTRY SitelD: 015-021-003378 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 1CC1CC1 n7C L.V11 l~CL 111L11C11L l.1 C CLl1 11~J ~_ _ V l..ilct itG.7Vl11 VC t'1l. 1.1 VQl.l Vll -7- 02/06/2007 rF SOUTHWEST FAMTLY DENTISTRY SiteID: 015-021-003378 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ aYC~:ial ncic~aiu5 ~~ill~y oiiu~-vl.l_~ ~„ , L-lic riv~.c~.. ~ ravail . vva~.cl 171.11 14.l lly Vt.V I.l~J0.111.y LCVC1 -8- ~ 02/06/2007 iF SOUTHWEST FAMILY DENTISTRY SiteID: 015-021-003378 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training rc~yc a Held for Future Use riC1U LVL t LLI.ULC U.7-C -9- 02/06/2007 „~ -,~ + SOUTHWEST FAMILY DENTISTRY __________________________ SiteID: 015-021-003378 + Manager Location: 1601 MILL ROCK'~'!Y City BAKERSFIELD BusPhone: (661) 833-0101 Map 123 CommHaz High Grid: 05D FacUnits: 1 AOV: CommCode: BFD STA 09 EPA Numb: SIC Code: DunnBrad: Emergency Contact / '~"itle Emergency Contact / Title ANTHONY G CHING DDS / OWNER / Business Phone: (661) 83.3-OlOlx Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press React ImmHlth DelHlth Contact ANTHONY G CHING DDS Phone: (661) 833-OlOlx MailAddr: 1601 MILL ROCK 't~lY State: CA City BAKERSFIELD Zip 93311 Owner SOUTHWEST FAMILY DENTISTRY Phone: (661) 833-OlOlx Address 1601 MILL ROCK 't?x1Y State : CA City BAKERSFIELD Zip 93311 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 ~1,1 r~ ~~ ~ ~i V hh~, , ~U~~ Based on my inquiry of those indivldu+~ls r~~~~nsibl~ fcr ~s7ta~ning thQ informeti~n, 1 partlfy under i?t~nslty cf I~w that I wave ~®~spnally examined and am famlflar with th® information submitted and l?ellev© the inf®rrnetion is true, accurate, and c®rnplete. 3.1 `_,6 Signa ure Date -1- 03/10/2006