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HomeMy WebLinkAboutBUSINESS PLAN 11/13/2007u _ -. ;!SMILE CARE ~L2750 MING AVE. °^~ ~ ;. ~~ SMILE CARE __________________________________________ SiteID: 015-021-002324 + Manager BELEN MACIAS BusPhone: (661) 396-1701 Location: 2750 MING AVE Map 123 CommHaz High City BAKERSFIELD Grid: 12A FacUnits: 1 AOV: CommCode: BFD STA 07 SIC Code:8021 EPA Numb: DunnBrad: ------------------------------ ----------------------------------- Emergency Contact / Title Emergency Contact / Title BELEN MACIAS / MANAGER STACI CINDERS / BCK OFFICE SUPR Business Phone: (661) 396-1701x Business Phone: (661) 396-1701x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) ~- x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact STACI CINDERS Phone: (661) 396-1701x MailAddr: PO BOX 25096 State: CA City SANTA ANA Zip 92799-5096 Owner COMMUNITY DENTAL DBA SMILE CARE Phone: (714)- 850-3333x Address 2 MACARTHUR PL 700 State: CA City SANTA ANA Zip 92707 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN ~! ::':~.a ~,;'. r=~+~ it?Cit+if~t of thr,~S^ "~.~;~~'~'"~~:/.~~ 1(Sr (:riicittl~lK~ rle :rifCji'rn<9i+U(1, l CNiI!!~ under penaPty of law ;rat i have pers©nai(y examined and am familiar NJitii +he information submitted and believe tf?;; inforrna°ion i;, };'~;'. ,u urztt.•, _.:c? c;l7rn;~le±e. "' ~. :~~ra f~aie / '~/ ~~O -1- 10/31/2007 ~~ S '~y~ -j/ "J UNIFIED PROGRAM INSPECTION CIiECKLIST SECTION 1: Business Plan and inventory Program • ~ra1<it , D aRr~ r l~ BAKERSFIELD FIRE DEPT Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME ~M.II,E ~,~n.E INSP C N DATE ~t 04 INSPECTION TIME 3o Mw. ADDRESS 2~T 5 o N1-N~ HONE NO. 3q~-~~o O OFEMPLOYEES FACILITY CONTACT~~~ ~ ~I ~ USINESS ID NUMBER 15-021- Section 1: Business Plan and Inventory Program ~'~ d ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ _~ BUSIfI@SS PLAN CONTACT INFORMATION ACCURATE ,~ Q r ` ~~J~AC~'r ~-1 v T" ~ ~~.I~ ISO 'C^Q ~ J . ^ VISIBLE ADDRESS ^ 111 """ CORRECT OCCUPANCY ~ ~ ,~ ^ ~j ~ " VERIFICATION OF INVENTORY MATERIALS ~~ ~/1, ~~~(~ $ ~nn 1~ " ~ (!(f "~ ^ v VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND CEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HA EXPLAIN: DO S WASTE ON SITE? J~YES ~_ fix _- - - •QUESTIONS REGARDING THIS INSPECPTION? PLEASE CALL US AT (661) 326-3 rV Inspector (Please Print) Fire Prevention / is~ In /Shift of Stte/Station # White -Prevention Services Yellow -Station Copy Pink -Business Copy FD2049 (Rev. 02/05) UNIFIED PROGRAM iNSPECT~ION CHECKLIST:;' ~~.~ ::M~a~£~;~.<f,~~ .~. _ _~~..E .~~-- >z~ rte.; ~ ~.. A~, :.,. . ~ ....~ .: ~ ... ., ...z . ~ ., , - SECTION 1: Busaness Pian and Inven#ory Program '~'' BAKERSFIELD FIRE DEPT Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME C INSPE TION D OZ T~ vJ INSPECTION TIC E M ~pv/ .~P~ ~ ~E ~/L~ ~ ADDRESS A`~ ~ ~ ~, ~ ~ A ` f ~F- HON NO.r 1~ O' 1/0 3 O F EMPLOYEES /p- FACIL TY CO T CT i~ ~~~~- ~ 3 ID NUMBER 1NES US 15-021- ®~~2-3 Z-''r~ Section 1: Business Plan and Inventory Program ~ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPEC.J~j~J ,~ C V (c=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ ~ BUSIfI@SS PLAN CONTACT INFORMATION ACCURATE ~i1 ~ ,/fj ~~ V ,~' l ^ 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 P CEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZA''~~ggO((U~~S WAS EvO,N nSITE? EXPLAIN: ~/~111~- ~~X~ ^ NO QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~~,g ~ -c. Inspector (Please Pnnt) Fire Prevention / ie' In /Shift of Site/Station # ~/RB n ARTM t r White -Prevention Services Yellow -Station Copy Pink -Business Copy FD2049 (Rev. 02!05) UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 rACILITV NAME ~ INSPECTION DATE I INSPECTION TIME I „n 1 ~ a l ~ l ~ ._. ~ •t ' O? j ~ C hw r '~.k~ ADDRESS PHONE No. No. of Employees ~, SO Ilh r v~ r ~J .~ n (, - (7 C ~ ~ ( S .... _ Business ID Number FACIUTYCONTACT _-_-_- --_~ - -_- _ _- __ J- Z~ z r , Irv1 e,s Y- ~. OC 1 S -021- c; o ~ 3 ~- r-/ Section 1: Business Plan and Inventory Pn~gram t~.Routine ^ Combined ^ Joint Agency ^hulti-Agency ^ Complaint ^ Re-inspection C ~I V ^ \y=Vioatoinncel OPERATION /APPROPRIATE JPERMIT ON HAND COMMENTS ® ^ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE VISIBLE ADDRESS iJ P 4,-~-e. c.~ ~.1-~c,~F- t h .r,..r, 4~, v r , ~ ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ~I ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITYE ^ ^ VERIFICATION OF HAT MAT TRAINING VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES l'~- ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ~J ^ HOUSEKEEPING ---- T ~ ' ~ ^ ^ ^ - --- FIRE PROTECTION -- SITE DIAGRAM ADEQUATE ~ ON HAND ------------- // ~' r}- ~ ~----------_._....---- ANY HAZARDOUS WASTE ON SITE: ~ YES ^ NO EXPLAIN: __ J~' 1~-~.. ~o_V`- I n.nP l' 0.~.. c~ ~r X~r QUESTIONS REGARDING TFIIS INSPECTIONS PLEASE CALL US AT ~6G'I ~ X26-3979 Inspector Badge No. White -Environmental Services Yellow • Station Copy Business a Responsible Party Pink -Business Copy + SMILE CARE _____________---__________________________= SiteID: 015-021-002324 + Manager HELEN ORTIZ BusPhone: (661) 396-1701 Location: 2750 MING AVE Map 123 CommHaz High City BAKERSFIELD Grid: 12A FacUnits: 1 AOV: CommCode: BFD STA 07 SIC Code:8021 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title HELEN ORTIZ / 5TACI /P~AICIr;. C~~CICE`,~L~ZR.~1 ~ Business Phone: (661) 396-1701x Business Phone: (661) 396-1701x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth 'DelHlth Contact HELEN OR_STACI Phone: (661) 396-1701x MailAddr: PO BOX 25096 State: CA City SANTA ANA Zip 92799-5096 ~`~F== ~~$ ~~~~~-----+ +-O ----------------~~1~'1r-U\~ 1~~f1~-~Q>Ac Ph wner Address : ~ one: ~~\L~ ~~~ ~~~~ State : CA Cit o~~~~ q'Z~-o~- 2~ ~~ Z1 ~ y P --- - - S(~c'N -~ ~ CPc Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ~ ParcelNo: ~ Emergency Directives: PROG A - HAZMAT ~~~~~~~ ~ zoos ~~s~ad ~fl ~y r~qq~iry of tYt6~a ihdl'vi~t~r~l~ responsible fop obtelnlr,~ thc~ Inforrri~tlon, i Cortlfy under p®n~lty of law that I hgve poPgpn~lly examined and $m farnillar w(th the jnfaerr-$tion submitted and bpllav0 the information is true, accurate, and (•a~ Signature --- Date -1- 03/09/2006 _ ~ .i ~` ,~ ~o~~ SMILE CARE Manager ('J 2~ ~Y~ ~U ~1 A S Location: 2750 MING AVE City BAKERSFIELD CommCode: BFD STA 07 EPA Numb: BusPhone: (661) 396-1701 Map 123 CommHaz High Grid: 12A FacUnits: 1 AOV: SIC Code:8021 DunnBrad: SiteID: 015-021-002324 Emergency Cont ct / Title Emergency Contact / Title (fie eve \QS/ '(`C~G.Y1O-~~`r STACI CINDERS / BACK OFF SUPR Business Phone: (661) 396-170 x Business Phone: (661) 396-1701x 2 4 -Hour Phone : ((o(o ~ ) ~ ''~ ~ a) $~ x 2 4 -Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact STACI CINDERS Phone: (661) 396-1701x MailAddr: PO BOX 25096 State: CA City SANTA ANA Zip 92799 -5096 Owner COMMUNITY DENTAL DBA SMILE CARE Phone: (714) 850-3333x Address 2 MACARTHUR PL 700 State: CA City SANTA ANA Zip 92707 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN ~a ~ Based ~ on my inquiry of those in iv1 responsible for obtaining the informatic~nd i oo<~tif , y under penalty of law that I have personally i exam ned and am familiar with the infortt~ation submitted and believe th e information is true, accurate, and complete. 0~ ZQ N~'~ I~ ~~ ~ ~ ~ Signature pal ~ ~~ , -1- 02/06/2007 -F SMILE CARE SitelD: 015-021-002324 ~ ~ 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 200.00 FT3 Hi OXYGEN F IH DH G 498.00 FT3 Low NITROGEN F P IH G 456.00 FT3 Min WASTE ABSORBANT F IH S 5.00 GAL UnR -2- 02/06/2007 -3- 02/06f2007 F SMILE CARE ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME NITROUS OXIDE . Location within this Facility Unit STORAGE RM STATE TYPE PRESSURE _ Gas TPure ~-Above Ambient SiteID: 015-021-002324 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 10024-97-2 TEMPERATURE CONTAINER TYPE - Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 FT3 200.00 FT3 200.00 FT3 nt~~~-itcuvu~ ~vlnrvlvniv l ~ °sWt . RS CAS# 100.00 Nitrous Oxide No 10024972 riHGHKL A~7 71"~~~1~11i1V 17 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0004 COMMON NAME / CHEMICAL NAME OXYGEN Location within this Facility Unit STORAGE RM STATE TYPE PRESSURE _ Gas TPure ~-Above Ambient Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 7782-44-7 TEMPERATURE CONTAINER TYPE Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 249.00 FT3 _ _ 498.00 FT3 498.00 FT3 riHGKttLVU.7 1.V1~lYUlVtS1V 1 J %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 t1HGEitCL 1-~bJJ;aJ1~1~1V1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -4- 02/06/2007 ;F SMILE CARE SiteID: 015-021-002324 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME NITROGEN Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM CAS# 7727-37-9 STATE TYPE PRESSURE ~~ TEMPERATURE ~ CONTAINER TYPE ~GaS TPure Above Ambient I Ambient I PnRT_ PRF.~S_ CYL,INDE~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 228.00 FT3 456.00 FT3 456.00 FT3 I1HG1-'1[CLV U,7 1.V1~1Y V1V L" 1V 1 A oWt. RS CAS# 100.00 Nitrogen No 7727379 I1L-1GtiCCL H. 7.7P~,7,71~1r,1V 1 b TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE ABSORBANT Days On Site 365 Location within this Facility Unit Map: Grid: STERILIZER RM CAS# ~SolidE TMixtur~AmbRent~E ~ AmbientT~E PlasticTBottles/Jug AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL HAZARDOUS COMPONENTS sWt. RSA CAS# HAZARD A SSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies. F IH / / / UnR -5- 02/06/2007 ,F SMILE CARE SiteID: 015-021-002324 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification ,_ r,lll~JlVyCC lVVl.11 j 1;VdUUdl.1V11 L'1LV111: 1VV 1.11. j~VdC:Ud 1.1 Vll. Emergency Medical Plan -6- 02/06/2007 -F SMILE CARE SiteID: 015-021-002324 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 1CG1C0.bG 1.V111.Q 111111G11L J ~...1CQ11 V~J V ~.11G1 n.c~V U1 ~.c t~~. l.lVQl.l Vll -7- 02/06/2007 .F SMILE CARE SiteID: 015-021-002324 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .7~JCl:ld1 Ild"GdL U.7' v~LLL~.y allu~.-vLL~ ~_ 1'LLC rLVLCI.../HVCL11 WdI~CL iJUl Lt.LL lll,. v~..~uNall~y LCVCL -8- 02/06/2007 .. ~ _ :F SMILE CARE SiteID: 015-021-002324 ~ . Fast Format ~ ~ Training Overall Site ~ _, J.alLL~J1VYcG 1 1 0. 111111y rayc c. lulu tvt 1'uI.ULC U.7C 11C1U 1VL L'I,LLULC U.5'C -9- 02/06/2007