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Home My WebLink AboutBUSINESS PLAN 3/22/2007~, WALGREENS #6756 I - ~~- - - 4306 MINA AVE. - - J - -- 11 cs ~~ y~sy~' ~~.~ !~ r- WALGREENS 6756 SiteID: 015-021-002398 Manager DAVE MARCUS BusPhone: (661) 827-9055 Location: 4306 MING AVE Map 123 CommHaz Mo~ate C( City BAKERSFIELD Grid: 02C FacUnits: 3 AOV: CommCode : BFD STA 0 7 SIC Code : 5 912 c¢t1.d ~1'3~`1 EPA Numb: DunnBrad:93-103-6651 .Emergency Contact / Title Emergency Contact / Title DAVE MARCUS / STORE MANAGER AGNES MACAPAGAL / DIST PHOTO SUPR Business Phone: (66'1)' 827-9055x Business Phone: (559) 307-7100x 24-Hour Phone (661) 663-0995x 24-Hour Phone (559) 307-7100x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press React ImmHlth DelHlth Contact 3~'~'3~ - 3~Cona,p clbQeyulc~-ar ~- 7~a o - -7vU `~ y ~ Phone : ~9~i-4 = 3-Y-9'S-x-' Ma i lAddr : X0.0-W3-LMO~' ~-~ME•2~~1 t °t 0~ Ito sti. five . State : -~, c~1 City ~R~'3-E•L~ Ca.rls ~a~ zip -6-9-03-5 `l ZLTO~ Owner WALGREEN CORP ~z_r~y Phone : (847) 914 -3-8~53x~ Address 200 WILMOT RD MS2171 State: IL City DEERFIELD Zip 60015 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif' d: RSs : No ParcelNo: Emergency Directives: PROG A - HAZMAT . boa F~ ~® ... l " ~~ s Based on my inquiry of those indAVidua if y responsible for obtaining the information, 1 cert rsonall I h ®®j' y ave pe under penalty of la~r~ that examined and am familiar with the information submitted and balieve the information is true, accurate, and complete. Signature Date -1- 02/20/2007 ~= F WALGREENS 6756 SiteID: 015-021-002398 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP F3~~R~ R~~L~''Id3-S-H~~i ~ ~'il~ri~' L 21.0 0 GAL H i ~-E3B~K ~ ~;i~~ L 15.8 0 GAL H i -~H3~ -~E~= ~ ~(,~T~ DH L 4 0 0 . 0 0 FT3 Mod SRS ~ EI.ET~ DH S 500.00 LBS Low REFRIGERANT R-22 P R IH G 258.00 FT3 Low `D~L~T~ IH L 31.50 GAL Low ~E~3~3M- ~i;LC"f~ F P IH G 1440.00 FT3 Min HELIUM F P IH G 220.00 FT3 Min WEE D~~~~ 'p ~~TE R L 2 0. 0 0 GAL Min FU-J~ ~~~~(~ L 1 . 6 0 GAL UnR -2- 02/20/2007 -3- 02/20/2007 F WAI,GREENS 6756 SiteID: 015-021-002398 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME FIXER AND REPLENISHER - ~ ~(~~~ Days On Site 365 Location within this Facility Unit Map: Grid: PHOTO LAB CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture Ambient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 21.00 GAL 10.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 75.00 Water No 7732185 1.00 Ammonium Thiocyanate No 1762954 5.00 Sodium Sulfite No 7757837 5.00 Ammonium Thiosulfate ~ No 7783188 5.00 Ammonium Thiosulfite No 010196040 t1HGEittL K.7 JL"a~51~1L'1V15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Hi -4- 02/20/2007 F WALGREENS 6756 SiteID: 015-021-002398 ~ ~ Inventory Item 0005 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME KODAK FLEXICOLOR _~' ~ ~~!~~ Days On Site STABILIZER AND REPLENISHER LF 365 Location within this Facility Unit Map: Grid: PHOTO LAB CAS# STATE__ TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~ Ambient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum 5.00 GAL 15.80 GAL riHGH.tCLVU~ l.LV1~lYV1Vl;1V15 %Wt. RS CAS# 95.00 Water No 7732185 1.00 Hexamethylenetetramine No 100970 1.00 Diethanolamine No 111422 1.00. 1,2-Propylene Glycol No 57556 1.00 Polyvinylpyrrolidone No 9003398 r1r~~t~tcL .ya ~r.~al~irivl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Hi Daily Average 7.90 GAL -5- 02/20/2007 F WALGREENS 6756 ~ Inventory Item 0009 COMMON NAME / CHEMICAL NAME LIQUID CLEANERS ._ ~~~~ Location within this Facility Unit RETAIL SALES FLOOR STATE TYPE PRESSURE Liquid TMixtur~ Ambient AMOUNTS AT THIS LOCATION Largest Container Daily Maximum 1.00 FT3 400.00 FT3 SiteID: 015-021-002398 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER HAZARDOUS COMPONENTS oWt. RS CAS# 5.00 Diethylene Glycol Monobutyl Ether No 112345 1.19 Alkyl Dimethyl Benzyl Ammonium Chloride No 68424851 t1HGl-'~1CL L~751";~~1~1L1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod ~ Inventory Item 0010 Facility Unit: COMMON NAME / CHEMICAL NAME LAUNDRY DETERGENTS ,._, ~~ L~ Location within this Facility Unit Map: RETAIL SALES FLOOR STATE TYPE PRESSURE TEMPERATURE Solid TMixtur~Ambient ~ Ambient Largest Container 15.00 LBS Daily Average 200.00 FT3 Fixed Containers at Site ~ Days On Site 365 Grid: BOX CAS# CONTAINER TYPE AMOUNTS AT THIS LOCATION Daily Maximum 500.00 LBS Daily Average 250.00 LBS HAZARDOUS COMPONENTS oWt. RS CAS# 40.00 Sodium Carbonate No 497198 1.00 Subtilisin No 9014011 t1HGH1CL L-~. 7 X71; ~ J1~1L' 1V l .J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Low -6- 02/20/2007 F WALGREENS 6756 SiteID: 015-021-002398 ~ ~ Inventory Item 0008 Facility Unit: Fixed Containers at Site ~ AME / CHEMICAL NAME COMMON N REFRIGERANT_R-22 Days On Site 365 i hi thi F ilit U i i M id G on w n ac y n Locat t s t ap: r : REFRIGERATION SYSTEM ( ~ sj~ CAS# 75-45-6 ~GaSATE T TYPE ~ Mixture I ~ PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE OTHER - SPECIFY AMOUNTS AT THIS LOCATION - Largest Container Daily Maximum I Daily Average 258.00 FT3 258.00 FT3 258.00 FT3 t1AGF~tCLV U.7 1.V1~lYV1V~1V 1 ~ oWt. RS CAS# 100.00 Chlorodifluoromethane No 75456 t1HGt1tCL H~Jr,~J1~1~1V 1,7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P R IH / / / Low ~ Inventory Item 0004 COMMON NAME / CHEMICAL NAME KODAK EKTACOLOR •- .~ ~ (~~ PRIME STABILIZER AND REPLENISHER/RA-4 Location within this Facility Unit PHOTO LAB STATE TYPE PRESSURE Liquid. TMixture I Ambient Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 7732-18-5 TEMPERATURE ~~ CONTAINER TYPE Ambient I CARBOY AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 31.50 GAL 15.75 GAL nHZARDOUS COMPONENTS oWt. RS CAS# 95.00 Water No 7732185 1.00 Polyvinylpyrrolidone No 9003398 1.00 Sodium Alkyl Ether Sulfate No 065858342 1.00 Magnesium Nitrate No 10377603 1.00 Substitute Thiazolin-3-One No nt~c~titcL ti~ ~a~ainatV t~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / Low -7- 02/20/2007 F WALGREENS 6756 SiteID: 015-021-002398 ~ ~ Inventory Item 0006 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME HELIUM - -- - `~~~ I ~ Days On Site 365 Location within this Facility Unit Map: Grid: OUTSIDE MANAGERS OFFICE CAS# 7440-59-7 ~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 180.00 FT3 1440.00 FT3 720.00 FT3 ntiatlttLVVJ l~Vl°lY V1V L'1V1J oWt. RS CAS# 100.00 Helium No 7440597 tll-~GL-1tVJ HJ w7L'JJ1"1P~1V1J __ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min ~ Inventory Item 0007 COMMON NAME / CHEMICAL NAME HELIUM Location within this Facility Unit RETAIL SALES FLOOR STATE TYPE PRESSURE _ Gas ~ure Above Ambient Facility Unit: Fixed Containers at Site ~ Days On Site 365 Ma Grid: P= ~ F-(0 CAS# 7440-59-7 TEMPERATURE CONTAINER TYPE Ambient PORT. PRESS. CYLINDER. AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 220.00 FT3 220.00 FT3 110.00 FT3 rls-~c~ti.lcl~vu~ ~:~1~ir~1v~1V 1 J %Wt. RS CAS# 100.00 Helium No 7440597 t1.HGHttL L~J.71;JJ1~11',1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -8- 02/20/2007 F WALGREENS 6756 ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME WASTE DEVELOPER ~~- '~ Location within this Facility Unit PHOTO LAB STATE TYPE PRESSURE Liquid TWaste ~mbient SiteID: 015-021-002398 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# TEMPERATURE CONTAINER TYPE _ Ambient DRUM/BARREL-NONMETAL AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 5.00 GAL 20.00 GAL 5.00 GAL rtt,atirc.LVUa ~.vi~irui~r,iv t S oWt. RS CAS# Silver No 7440224 t11~GHKL HJ ~~551~1~1V1a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME FUJI - '~ ~ Days On Site BLEACH 3 ST TER, REPLENISHER,CONDITIONING,STABILIZER 365 Location within this Facility Unit Map: Grid: PHOTO LAB CAS# Liquid TMixture ~ Ambient~E ~ AmbientT~E ~STOICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.60 GAL 1.60 GAL 1.60 GAL owt. RSI CAS# - HAZARD A SSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UnR HAZARDOUS COMPONENTS -9- 02/20/2007 F WALGREENS 6756 SiteID: 015-021-002398 ~ Fast Format ~ ~ Notif~./Evacuation/Medical Overall Site ~ ~ Agency Notification 11/04/2002 ~ IN THE EVENT OF A REPORTABLE RELEASE OR INCIDENT, THE MANAGER ON DUTY WILL NOTIFY WALGREENS EMPLOYEES AND CUSTOMERS OF THE EMERGENCY VIA THE FACILITIES PUBLIC ADDRESS SYSTEM, AND SHOUTING WHEN NECESSARY. MANAGEMENT TO VARIOUS WALGREENS EMPLOYEES WILL DELEGATE THE RESPONSIBLITY OF CONTACTEN NEIGHBORING FACILITIES WILL BE CONTACTED IN PERSON. IF AN EVACUATION IS NEEDED, AFTER THE INITIAL NOTIFICATION HAS BEEN GIVEN, WALGREENS PERSONNEL AND CUSTOMERS WILL BE ESCORTED THROUGH EMERGENCY EXITS LOCATED THROUGHOUT THE FACILITY. EXITS ARE CONSPICUOUS AND ILLUMINATED, THE EMERGENCY ASSEMBLY AREAS ARE LOCATED IN THE PARKING LOT IN THE FRONT OF THE STORE, AND IN THE REAR OF THE STORE NEAR RECEIVING. THE EMERGENCY ASSEMBLY AREA WILL DEPEND ON THE EXTENE AND LOCATION OF THE INCIDENT. THE STORE MANAGER ON DUTY IS RESPONSIBLE FOR THE ACCOUNTING OF ALL EMPLOYEES AND CUSTOMERS. WALGREENS STORE MANAGEMENT WILL ASSIST ALL EMERGENCY RESPONDERS DURING A FACILITY INCIDENT AS NEEDED. Employee Notif./Evacuation 08/17/2006 PHOTOGRAPHIC CHEMICAL SPILLS WILL NORMALLY BE HANDLED BY STORE EMPLOYEES. IF NON-EMERGENCY ASSISTANCE IS NEEDED, EMPLOYEES SHOULD CONTACT QUALEX, INC. AT 800-452-2911. IF EMERGENCY ASSISTANCE IS NEEDED, EMPLOYEES SHOULD DIAL 911. ,~ rur~lic 1voLiz . / ~vacuaLion -10- 02/20/2007 F WALGREENS 6756 SiteID: 015-021-002398 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Emergency Medical Plan 08/17/2006 ~ IN THE EVENT OF A MEDICAL EMERGENCY THE MANAGER ON DUTY WILL BE NOTIFIED AND WILL ASSIST THE SITUATION IF POSSIBLE. IF NECESSARY, 911 WILL BE CONTACTED FOR EMERGENCY ASSISTANCE. SOUTH MEDICAL PAVILLION, MERCY WAY, 663-6000. -11- 02/20/2007 F WALGREENS 6756 SiteID: 015-021-002398 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention 08/17/2006 ALL EMPLOYEES ARE TRAINED ON THE PROPER HANDLING AND STORAGE OF HAZARDOUS MATERIALS. HAZARDS ARE MAINLY IN THE PHOTO PROCESSING CENTER. ALL OTHER HAZARDOUS MATERIALS IN THE FACILITY ARE PREPACKAGED CONSUMER PRODUCTS FOR RETAIL SALE. 9 9 Release Containment 08/17/2006 IN THE EVENT OF A SPILL, ALL PRODUCTS WILL BE CLEANED UP USING IN-HOUSE EQUIPMENT(IE, ABSORBENTS, BROOMS, GLOVES, ETC). PRODUCTS ARE DISPOSED OF ACCORDING TO ALL LOCAL, STATE, AND FEDERAL REGULATIONS. IN THE EVENT OF A FIRE, IF SAFE TO DO SO, EMPLOYEES WILL ATTEMPT TO EXTINGUISH FIRES WITH FIRE EXTINGUISHERS LOCATED THROUGHTOUT THE BUILDING. THE MANAGER ON DUTY WILL BE RESPONSIBLE FOR CONTACTING 911 IF THE FIRE IS UNCONTAINABLE OR OUT OF CONTROL. IN THE EVENT OF AN EARTHQUAKE, ALL EMPLOYEES AND CUSTOMERS WILL BE DIRECTED AWAY FROM THE SHELVING AND WINDOWS. AFTER THE QUAKE THE MANAGER ON DUTY OR OTHER DESIGNATED PERSONNEL WILL CHECK THE WINDOWS FOR CRACKED GLASS, LOOK FOR LOOSE FIXTURES, AND CHECK ALL UTILITY MAINS FOR LEAKS. IF LEAKS ARE SUSPECTED, THE STORE WILL BE EVACUATED, THE MAINS WILL BE SHUT OFF, AND THE AUTHORITIES WILL BE NOTIFIED. IN ADDITION, ALL HAZARDOUS MATERIAL STORAGE AREAS WILL BE SEARCHED FOR ANY SPILLED MATERIALS OR DAMAGED AND LEAKING CONTAINERS. SPILLED MATERIALS WILL BE PROMPLY ATTENDED TO. Clean Up 08/17/2006 IN THE EVENT OF A SPILL, ALL PRODUCTS WILL BE CLEANED UP USING IN-HOUSE EQUIPMENT (IE, ABSORBENTS, BROOMS, GLOVES, ETC). PRODUCTS ARE DISPOSED OF ACCORDING TO ALL LOCAL, STATE, AND FEDERAL REGULATIONS, -12- 02/20/2007 F WALGREENS 6756 SiteID: 015-021-002398 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ i L . Ul.i1CL K~~UUrC~ HCt,1Vdl.lUil_ -13- 02/20/2007 F WALGREENS 6756 SiteID: 015-021-002398 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ aNc~..ial nac~a.LUc Utility Shut-Offs 08/17/2006 ELECTRICAL: OUTSIDE N SIDE OF BLDG WATER: OUTSIDE W SIDE OF BLDG SPECIAL: OUTSIDE SW SIDE OF BLDG LOCK BOX: YES OUTSIDE LEFT SIDE OF MAIN ENT Fire Protec./Avail. Water 08/17/2006 PRIVATE FIRE PROTECTION: FIRE EXTINGUISHERS THROUGHOUT STORE, AUTOMATIC FIRE ALARM SYSTEM, AND AUTOMATIC FIRE SPRINKLER. FIRE HYDRANT: STINE RD FRONT OF STORE. Building Occupancy Level 08/17/2006 26 EMPLOYEES -14- 02/20/2007 F-WALGREENS 6756 SiteID: 015-021-002398 ~ Fast Format ~ ~ Training Overall Site ~ ~--Employee Training 08/17/2006 ~ MSDS SHEETS OF FILE. BRIEF SUMMARY OF TRAINING PROGRAM: ALL EMPLOYEES ARE TRAINED ON THE PROPER HANDLING AND STORAGE OF HAZARDOUS MATERIALS, HAZARDS ARE MAINLY IN THE PHOTO PROCESSING CENTER, ALL OTHER HAZARDOUS MATERIALS IN THE FACILITY ARE PREPACKAGED CONSUMER PRODUCTS FOR RETAIL SALE. TRAINING COVERS SAFE HANDLING PRACTICES, CALLING 3E CO TO OBTAIN MSDS VIA FAX ON DEMAND, EMERGENCY RESPONSE PROCEDURES, AND OTHER AREAS. TRAINING IS PROVIDED UPON INITIAL HIRING, AND TO ALL EMPLOYEES ON AN ANNUAL BASIS. TRAINING PROVIDES EMPLOYEES WITH SKILLS AND SUPPORT TO ADOPT TO SAFE WORK PRACTICE, TO PREVENT ACCIDENTS AND TO IMPROVE THEIR WORK ENVIRONMENT. rayc c. rie1Q =Or 1"l1LUL-e VSe -15- 02/20/2007 F WALGREENS 6756 SiteID: 015-021-002398 ~ Fast Format ~ ~ Training Overall Site ~ Held for Future Use -16- 02/20/2007 CALIFORNIA ANNOTATED SITE MAP (BUSINESS NAME°WALGREENS #6756 (SITE ADDRESS~BAKERSFIELD, CA 93309 I Map #:1 ^F 2~ A B C D E F G H I 1 :NORTH ~_ 'na F S ~ ~~ . 2 3 4 5 6 7 Y X -~ ~ ~ ~ /F SK . ~ p 1 3E ..._~. ~~ S 1 SK SPILL KIT FIRST AID a LOCK BOX R-22 REFRIGERANT COMPRESSED CAS Q CYLINDERS (xeuur) FIRE EXTINGUISHER ALIFGRNIA ANNOTATED SITE MAP I BUSINESS NAME: WALGREENS #6756 ( SITE ADDRESS: 4306 MIG AVENUE I Map #:2 of 2I BAKERSFIELD, CA 93309 A B C D E F G H I 2 3 4 5 s ~' NORT W PARKING z wOREC'G Q O PARKI G z F--~ z ^^ r v Q~ Q ~ . - ..... ............ . ~ ~ ... .. ' \ U E 0 ARKI G . ............ .. PARKING PARKI G PqR ST ING SAD 1 SCA E~ NOT 7^ SCALE 3E ' 03/02/2007 SAFE REFUGE AREA ® STORM DRAIN FIRE HYDRANT O ELECTRIC MAIN OG GAS MAIN O WATER MA[N Y X -~ • 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 FACILITY NAME ~ INSPECTION DATE INSPECTION TIMF~ ADDRESS ~M ~ J -r ' ` ~ ~/1 G ~.~t_ --------- _ ~ PHONE No. No. of Emfployees ~~-7' Cllr S5 -->~--1 FACI ITYCONTACT G i' /L Business ID Number 15-021-p(723~t8' ( L t t L_ _Ci • n U Section 1: Business Plan and Inventory Program Routine ^ Combined D Joint Agency ^Mutti-Agency ^ Complaint ^ Re-inspection C V (C=Compliance, OPERATION `V=Violation J COMMENTS. ,Ian ^ APPROPRIATE PERMIT ON HAND ~~ jn~ w~( Icy„ ~ ~ ~ ~ FD ^ _ _ BUSINESS PLAN CONTACT INFORMATION ACCURATE - - ~ - _ ~` ~ r ~ t~ 3I __ O ---ttt'C-C:r:~ r ^ ------------------ -- - - ----- VISIBLE ADDRESS ----- _ - ---- . -- ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS KJ ^ VERIFICATION OF QUANTITIES ~J ^ VERIFICATION OF LOCATION ~~~ ~~~ I~ ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITYE -- -- ^ -- ----- ------------------------- VERIFICATION OF HAT MAT TRAINING --- --- ----------------- I~ ""^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~J ^ EMERGENCY PROCEDURES ADEQUATE ~ V I(J ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ------------------- I~ ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE: YES EXPLAIN: ~I 1/1 ni~n . hJ~ f! No QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US ATQ~66~ ___ _ ~ ~~ __~_ _L~ ----- I for ~ii Responsible Party White -Environmental Services Yellow -Station Copy Pink -Business Copy (HMMt~ HAZARDOI~S ~ATEIRIAL3 MANAGEMENT i?LAN ~~'' (DIED PROGRAM (ANSOI.DiATED FORM) APPLICATION 8US/~ESS OVNtER/OPEdiAT~ORD~i1fiCJCf10N FORM (HAZARDOUS MATERIALS FACILITY INFORMATION) I-/tL ~~sr BAKERSFIELD FIRE DEPT. P:eveatioa Sesvices 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 2 ~~ L FACILITY IDENTIFICATION ' FACILITY ID NO. t Year tW Year Endl tet 03/15 2006 03/15/207 BUSINESS NAME (Same ae FACILITY NAME or OBA- Doke ewlnese At) ~ BUSINESS PHONE mt Walgreen's #6756 661-827-9055 srtE ADDRESS ,p, 4306 Ming Avenue Bakersfield to• CA 3309 ~ 9~~~~ ~~ 206 ~ t4 p~°s°j 5912 & 7384 'p' Ba~CerNS~ield ~ __pPP~~RRAATOR NEE Walgreens (:orporation toe OPERATOR HONE (847) 914-3853 ttp ;. . .... .. `, II::OWNER INFORMATI~I OWNER NAME +++ OWNER PHONE to Walgreens Corporation (847) 914-3853 OWNER MAILING ADDRESS tts 200 Wilmot Road CITY t1Y STATE tts IP tte Deerfield )Z ~ 60015 III. ENVIRONMENTAL CONTACT CONTACT NAME to CONTACT PHONE ne Christina Chiappetta, Safety and Compliance Environmental Supervisor, MS2171 (847) 914-3195 CONTACT MAILING ADDRESS tto 200 Wilmot Road cm +2o STATE >r ZIP +~ Deerfield IL 60015 - PRIMARY ,' Iv. E~IEROeNCV coN TACrs -SECONDARY- NAME 123 NAME 128 Steven Smith Agnes Macapagal Tn'lE 124 TITLE 129 Store Manager District Photo Supervisor BUSINESS PHONE 125 BUSINESS PHONE 130 661-827-9055 559-307-7100 `, 24-HOUR PHONE 128 24HOUR PHONE \ 131 661-663-0995 559-307-7100 ~O PAGER NO. 127 PAGER N0. ~ 132 N/A N/A 133 ,. , ,. ,. .. . :. V. CERTIFICATION ,.; , Certification: 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 in this inventory and believe the information is true, acalrate, and complete. SIGNATURE OF SIGNER 138 DATE 134 NAME OF DOCUMENT PREPARER 135 03/15/2006 Melissa LaBanc, A ent for Wal reens Co oration NAME OF OWNERlOPERATOR (SDIGNATURE 8 PRINT) 137 TRLE OF OWNER/OPERATOR 138 Dean Jarrett Divisional Merchandise Manager FD 2142 (Rev. 09/05) CALIFpRNIA ANNOTATED SITE MAP I BUSINESS NAME WALGREENS #6756 I SITE ADDRESS~4306 MING AVENUE Map #~I of 2 BAKRSFIELD, CA 93309 A B C D E F G H I 1 2 3 4 5 6 ~' I `~ - J L F _.__ ~._ ~,' ~~ ® ~ + ' ;.~_ ~ <. ~ ~ scE 3E INED SK SPILL KIT FIRST AID a FIRE EXTINGUISHER LOCK BOX ~~ b~ LC L1QU1D CLEANER R-22 REFRIGERANT LAUNDRY DETERGENT SOLID ('y~ COMPRESSED GAS W CYLINDERS (xeuuw) NFG NON FLAMMABLE GAS IRR IRRITANT Site Diagram Y X --~ ALIFORNIA ANNOTATED SITE MAP BUSINESS NAME: WALGREENS #6756 SITE ADDRESS: 4306 MIG AVENUE Ma #:2 of 2 BAKERSFIELD, CA 93309 F A B C D E F G H I 1 2 3 4 5 s T r. NORT W PARKING z W OREC'G Q O PARKI G z i--i z Y Q 0_ E O~ PARKI G ~® ~ PARKING PARKI G PqR ST ING SAD 1 SCA E~ 3E NOT TO SCALE ;i SAFE REFUGE AREA ® STORM DRAIN FIRE HYDRANT O ELECTRIC MAIN GO GAS MAIN O WATER MAIN Y X -~ ~. BAKERSFIELD FIRE DEPT Prevention Services UNIFIED PROGRAIN INSPECTION CIiECKLIST r E!Q/ 1 D 90o T'ruxtun Ave., Suite 210 ~...-w~~~x,~. ~_ . _ Fy.~ .~, ,.~ ...~~ ,~ __:~~ .~,..~,~~.:. ~.- ~:.~ . .:... .. . ...:<4, : , r: ,~n ~;`~ aRnM s Bakersfield, CA 93301 SECTION 1 : BIISIn@SS Plan 811d InV@11#OB~/ PI'Ogt'a111 Tel.: (661) 326-3979 • Fax: {661) 872-2171 FACILITY NAME INSPECTION DATE ^ INSPECTION TI E ~ ~ ` ADDRESS I'Yl HONE NO. a ~ ~~ ~ NO OF EMPLOYEES zs- ( ~ - FACILITY CONTACT ~~ 6~~- ~6~-oti ~~ 5 t 5 ' U NESS ID NUMBER ~s-o2~- c~v~32~ ,,,,, vc N Section 1: Business Plan and Inventory Program ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION • C V (~=Compliances OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSin2SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS iB' ^ CORRECT OCCUPANCY O VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES L L} , . ,/ l~ ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY I°f ^ VERIFICATION OF HAZ MAT TRAINING - ~Pk~ ~ ~r~J`1i/ GY ^ VERIFICATION OF ABATEMENT SUPPLIES AND RO CEDURES P - / L'J' ' ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND /" ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Ple Print) Fire Prevention / 1`~ In I Shift of Site/Station p ^ YES Cd' NO White -Prevention Services Yellow -Station Copy Pink -Business Copy FD2049 (Rev. 02105)