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Home My WebLink AboutBUSINESS PLAN 3/27/2006 . I ' ROSEWOOD. RETlREM.. EN. T COMMUN~ J 1301 NEW STINE ROAD .---- -- - ---_.-- ,-- ~. -~- ,..' _' .r'., ,~,,;-,.::_~--~::-~:, ~.. '... ~\ , ~7A. * ,~ J 1,.,1,. ',~; ~ ~ 5-3-QO _ ~~~ /.)0 Uvu ~~. ~kL- ~cL. vrw.chcL to Jhcwe.- ~ u..pdJJtLd.' ~ q) 1ffi(J1:iYJ1 00 ~ ~~&.. to.M, LJ~ ~ ~, JJe.., ~'V ~~ 0lt..$M\a{ ,tv -p.-Ck.. u.p ~Yf\A ,..' .:; - I J.j - 9'D <;ff;Jf tA1Af - yd2 ~ - jaMi N'rFt' i~ Cf4 j ~~ ~,~,~.~ ,U-.2~-Cl' ~ ~'~ -~ ~ (}lvl U\JL; ciLo...a>:,-16 ""t:aAJe..; ~L ~ ~ CJ..4'... 0vUtrue ~ ~ a ~oa. 03 <t~a/lA... a-~ . ~ ~ 4b()1Lcr~ ~ ift.-~ ~I '\ ( ~--~~m"m.fJlIm._ , ~'-'_ _- -o=--=-o=-~,~~",.,..,.,=~~~,~..._,,-,.;,J --- ,---- , ';&<1: \ -y ';j':" ~ + ROSEWOOD RETIREMENT COMMUNITY Rob\n R. f<.o~ Manager.: ~E!.iL R~ERKINS Location: 1301 NEW STINE RD City BAKERSFIELD ======================= SiteID: 015-021-001058 + BusPhone: Map : 123 Grid: 03D (661) 834-0620 CommHaz : High FacUnits: 1 AOV: CommCode: BFD STA 07 SIC Code:8059 EPA Numb: DunnBrad:94-122-5374 +==============================================================================+ +=======================================+======================================+ Emergency Contact / Title ~ergency Contact / ~~---- TED BURGESS / ADMINISTRATOR TE'RI<YN TH ~-gST ADMIN Business Phone: (661) 834-0620x502 Busin~ss Pho 61) 834-0620x131 24-Hour Phone : (661) 391-9724x 24-Ho~ one : (661 ~3x Pager Phone : (661) 85.2-9720x ~gErr""Phone: (661) 852-97~ +---------------------------------------+--------------------------------------+ I Hazmat Hazards: Fire Press React ImmHlth DelHlth I +-----------------------------~---,--F)------------------------------------~---+ Contact : fr~LL R -r'.t:1'<.K:t!\l'S R.Q)bHi f'"(.~ Phone: (661) 834-0620x '020 MailAddr: 1301 NEW STINE RD State: CA City : BAKERSFIELD Zip : 93309 +---------------------------------------------------~--------------------------+ Owner AMERICAN BAPTIST HOI1ES 'd Phone: (925) 924 -7100x Address : ,~-&9- ~\~ Stvf\e..n C~ mo...u Rd. State: CA +-~~=~----~-~------~JC~r~-q~$8f'-----~~~--~:=~~--------------+ Period to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif I d: _ RSs: No ParcelNo: +------------------------------------------------------------------------------+ Emergency Directives: PROG A - HAZMAT PROG C - COMM HOOD PROG T - ABOVEGROUND STORAGE TANK Based on my inquiry of those Individuals responsible for obtaining the information, I cartlfy unde~ penalty of law that I have personally examl.ned and am familiar with the Information submItted and beliave the information is true a::curat_rand compklte 3! J 1/ Df; ENT7J A p R 1 4 2006 +==============================================================================+ -1- 03/22/2006 ~~ o hl Stora2e Stora2e ,~ 111? 111~ i~ . 1110 1111 Rosewood Retirement 1108 1109 Health Cent 1106 1107 1301 New Stin 1104 1105 Bakersfield, Ca ~ 1102 110~ I P"""'4. Central TV Lounge -Storage Activity 1101 I +-8torage Dining Lobby Area 1 1 1 1 1 1 1 1 s T Room Offit"P 3 3 3 TV 3 3 3 3 3 0 R 0 0 0 Lounge 0 1 1 1 1 A I Restrooms m G Social Office 2 4 6 8 0 2 4 6 E Services 4t- Kitchen Beauty Lockers Physical Office M Office Salon Therapy D u s S Stora2e 1 1 1 B L 1 1 1 1 T A i T c 3 3 3 I 3 3 3 3 Stora2e T R 0 0 0 n L 0 0 1 1 A H e I G 1?M 1 3 5 T 7 9 1 3 E n v Utility Launel!] Folding LJ Closet Room Storage Rose -Storugc Storage 1?04 Room 1?On E Patio Storage Nurses ~. Sta tion 1?01 1?OA ~~ N ~Q 1?m 1?10 0CGde0l -Proal doset 1?OFi 1?1? ~, (\ O~tc: Side- cf 1?07 1?14 w CLU ' 1?OQ 1?1n Storage Stora2e ~ e t 9 U"J(ors(Jold, CA 9JJ09 ,.,Jl4U ~v SOt4/l/lJM rr\Tnr~~N~J~ ' ~,~. .uJJj_LL~ f/), 'y j ,~ /' (\) , ~ iTRUCTlONS: rdor'!o OvaCllalo, rol/ow red IInos 10 Iho noarO~/_ _ lablo OX.'I. EVacllalo Only on orders rroln Iho Fire 1:1.""" arlmonl, AdmltIlSlralor.ltl_Char[/o. or fIll"ido", _, 'r Caplaln. EXIT VIA ST AlfIS ONLY. ---"u, DON 0 T Us r: r: '- r: V ^ Tn n ('I EVACUATION ROUTES ASSISTED LIVING 2.Jld ~loo r t' h RiSe. I3tctg, LIBRARY _ (j) . CI.OSf:T ~\ ...........,.......... ......rOlf/l.(; -- ~~,~.~- it 1224 \ "-.......................-- 'i""'" 1 " ,'" ,:/.... A' ~. :f Manager : Location: City BusPhone: Map : 123 Grid: 03D SiteID: 015-021-001058 935"" :;J.!;~ (661) ~Q~ CommHaz : High FacUnits: 1 AOV: ROSEWOOD RETIREMENT COMMUNITY C/H-. ~J,J...Su.P RBB.fN R ROCH..7\4 1301 NEW STINE RD BAKERSFIELD CommCode: BFD STA 07 EPA Numb: SIC Code:8059 DunnBrad:94-122-5374 Emergency Contact / Title Emergency Contact / Title TED BURGESS / ADMINISTRATOR CAL. ~J.J-5U.p / f)/~. &p F;getJJTif.S Business Phone: (661) 834-0620x502 Business Phone: (~61 ) fB:3S- - .P-!7~'k 24-Hour Phone ,. (661) 391-9724x 24-Hour Phone : ("'I )3f)3 - '-a;qga x Pager Phone : (661) 852-9720x Pager Phone : ( ) - x Owner Address City AMERICAN BAPTIST HOMES : 6120 STONERIDGE MALL RD 3RD FL : PLEASANTON Fire Press React ImmHlth DelHlth Phone: (661) .~~~~~~~ State: CA Zip : 93309 Phone: (925) 924-7100x State: CA Zip : 94588 Hazmat Hazards: Contact : ROBIN R ROCHA MailAddr: 1301 NEW STINE RD City : BAKERSFIELD Period : Preparer: Certif'd: ParcelNo: to TotalASTs: = TotalUSTs: = RSs: No Gal Gal Emergency Directives: PROG A - HAZMAT PROG C - COMM HOOD PROG T - ABOVEGROUND STORAGE TANK fNTD J VL 2 3 ZODl . ' of those individuals 138;o8d on my I!;~u.lry hP. i~format\on, \ certify resporr3ibie lor Obf3.:nIl1gt~..~t \ have personally unde: penal~ 0 f~~~i1\a~ with the infOl:mation examined, an _) ~':li(3Ve the information IS true, SlIomlltea anI" - ~ , accurate. and complete. -/1 Il~ _2::l~? _~- . - .", - Date SiY'lature -1- 07/13/2007 ~ ii. F ROSEWOOD RETIREMENT COMMUNITY SiteID: 015-021-001058 9 p= Hazmat Inventory By Facility Unit =, f== MCP+DailyMax Order Fixed Containers on Site =, Hazmat Common Name. . . IspeCHaz\EPA Hazards I Frm I DailyMax lunitlMCP ACETYLENE E F P IH G 135.00 FT3 Hi DE STAINER DH L 30.00 GAL Hi HOUSEHOLD BLEACH F R IH DH L 12.00 GAL Hi GREASECUTTER F R IH DH L 6.00 GAL Mod OXYGEN 02 F IH DH G 770.00 FT3 Low OXYGEN 02 G 250.00 FT3 Low DIESEL F IH DH L 240.00 GAL Low OXYGEN F IH DH G 170.00 FT3 Low OXYGEN F IH DH G 170.00 FT3 Low OXYGEN F IH DH G 145.00 FT3 Low HYDRAULIC OIL F DH L 30.00 GAL Low NITROGEN F P IH G 258.00 FT3 Min -2- 07/13/2007 U ,7 -3- 07/13/2007 " F ROSEWOOD RETIREMENT COMMUNITY p= Inventory Item 0002 = COMMON NAME / CHEMICAL NAME ACETYLENE SiteID: 015-021-001058 , Facility Unit: Fixed Containers on Site=, Days On Site 365 Location within this Facility Unit MAINTENANCE SHOP Map: Grid: CAS # 74-86-2 STATE - TYPE Gas Pure PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 300.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 135.00 FT3 Daily Average 135.00 FT3 HAZARDOUS COMPONENTS I~ CAS # 748621 %Wt I 100.bo Acetylene TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi HAZARD ASSESSMENTS f= Inventory Item 0007 = COMMON NAME / CHEMICAL NAME DESTAINER Facility Unit: Fixed Containers on Site=, Days On Site 365 Location within this Facility Unit LAUNDRY N WING HEALTH FAC Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 15.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 30.00 GAL Daily Average 30.00 GAL %Wt. RS CAS # 8.00 Sodium Hypochlorite No 7681529 HAZARDOUS COMPONENTS A E MENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Hi HAZARD SS SS -4- 07/13/2007 'I; SiteID: 015-021-001058 , Facility Unit: Fixed Containers on Site=, F ROSEWOOD RETIREMENT COMMUNITY F Inventory Item 0008 = COMMON NAME / CHEMICAL NAME HOUSEHOLD BLEACH Days On Site 365 Location within this Facility Unit STORAGE RM E WING HEALTH FAC Map: Grid: CAS # 7681529 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 1.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 12.00 GAL Daily Average 12.00 GAL %Wt. RS CAS # 5.00 Sodium Hypochlorite No 7681529 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F R IH DH / / / Hi HAZARD ASSESSMENTS p= Inventory Item 0005 = COMMON NAME / CHEMICAL NAME GREASECUTTER Facility Unit: Fixed Containers on Site=, Days On Site 365 Location within this Facility Unit DIET CLEAN SUPPLY CLOSET Map: Grid: CAS# STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 6.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 6.00 GAL Daily Average 6.00 GAL U 0 PONENT %Wt. RS CAS # 4.00 Sodium Hydroxide, Solution No 1310732 10.00 2-Butoxyethanol No 111762 'HAZARDO S C M S HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F R IH DH / / / Mod -5- 07/13/2007 (f, F ROSEWOOD RETIREMENT COMMUNITY F Inventory Item 0010 F= COMMON NAME / CHEMICAL NAME OXYGEN 02 SiteID: 015-021-001058 9 Facility Unit: Fixed Containers on Site=, Days On Site 365 Location within this Facility Unit 1ST FLR 02 STORAGE CLOSET Map: Grid: CAS # 7782-44-7 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 390.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 770.00 FT3 Daily Average 770.00 FT3 Z P %Wt. RS CAS # 100.00 Oxygen, Compressed No 7782447 HA ARDOUS COM ONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low HAZARD ASSESSMENTS p= Inventory Item 0014 = COMMON NAME / CHEMICAL NAME OXYGEN 02 Facility Unit: Fixed Containers on Site=, Days On Site 365 Location within this Facility Unit 2ND FLR 02 STORAGE CLOSET Map: Grid: CAS # 7782-44-7 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 250.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 250.00 FT3 Daily Average 250.00 FT3 PO NTS %Wt. RS CAS # 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COM NE A ESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Low HAZARD SS -6- 07/13/2007 :r: " F ROSEWOOD RETIREMENT COMMUNITY p= Inventory Item 0003 = COMMON NAME / CHEMICAL NAME DIESEL SiteID: 015-021-001058 , Facility Unit: Fixed Containers on Site=, Days On Site 365 Location within this Facility Unit ABOVEGROUND TANK Map: Grid: CAS # 68476-34-6 STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE ABOVE GROUND TANK Largest Container 250.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 240.00 GAL Daily Average 240.00 GAL ZARD %Wt. RS CAS # 100.00 Diesel Fuel No. 2 No 68476302 HA OUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No NO/ Curies F IH DH / / / Low HAZARD ASSESSMENTS f= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME OXYGEN Facility Unit: Fixed Containers on Site=, Days On Site 365 Location within this Facility Unit MAINTENANCE SHOP Map: Grid: CAS # 7782-44-7 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 250.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 170.00 FT3 Daily Average 170.00 FT3 %Wt. RS CAS # 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -7- 07/13/2007 ,i !'! F ROSEWOOD RETIREMENT COMMUNITY p= Inventory Item 0009 = COMMON NAME / CHEMICAL NAME OXYGEN SiteID: 015-021-001058 , Facility Unit: Fixed Containers on Site, Days On Site 365 Location within this Facility Unit HEALTH FAC Map: Grid: CAS # 7782-44-7 STATE - TYPE Gas Pure PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 300.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 170.00 FT3 Daily Average 170.00 FT3 %Wt. RS CAS # 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low HAZARD ASSESSMENTS Facility Unit: Fixed Containers on Site ~ f= Inventory Item 0013 = COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit CHILLER RM Map: Grid: CAS # 7782-44-7 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 145.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 145.00 FT3 Daily Average 145.00 FT3 T %Wt. RS CAS # 100.00 Oxygen, Compressed No 7782447 HAZARDOUS COMPONEN S TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low HAZARD ASSESSMENTS -8- 07/13/2007 .~" I~ ,;., F ROSEWOOD RETIREMENT COMMUNITY p= Inventory Item 0011 = COMMON NAME / CHEMICAL NAME HYDRAULIC OIL SiteID: 015-021-001058 9 Facility Unit: Fixed Containers on Site=, Days On Site 365 Location within this Facility Unit GARDEN SHOP MAINTENANCE SHOP Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 30.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 30.00 GAL Daily Average 30.00 GAL %Wt. RS CAS # 100.00 Hydraulic Brake Oil (Diethylene Glycol Monobuty... No 0 HAZARDOUS COMPONENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low HAZARD ASSESSMENTS p= Inventory Item 0012 F= COMMON NAME / CHEMICAL NAME NITROGEN Facility Unit: Fixed Containers on Site 9 Days On Site 365 Location within this Facility Unit MAINTENANCE SHOP Map: Grid: CAS # 7727-37-9 - TYPE Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 258.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 258.00 FT3 Daily Average 258.00 FT3 %wt. I 100.00 Nitrogen HAZARDOUS COMPONENTS ~ CAS# 77273791 A NT TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min HAZARD SSESSME S -9- 07/13/2007 '\:l ~~ !;.'I F ROSEWOOD RETIREMENT COMMUNITY I f= Notif./Evacuation/Medical Agency Notification SiteID: 015-021-001058 =, Fast Format =, Overall Site=, 01/23/2001 CALL 911. Employee Notif./Evacuation 04/14/2006 NOTIFICATION AND EVACUATION PROCEDURES ARE DESCRIBED IN AN INTERNAL AND EXTERNAL DISASTER MANUAL MAINTAINED IN THE FACILITY. STAFFING IS ON A 24-HOUR PER DAY BASIS WITH KEY ADMINISTRATIVE AND MAINTENANCE PERSONNEL ON CALL AFTER NORMAL OFFICE HOURS. EVACUATION WOULD COME ONLY UPON THE ORDER OF THE PERSON-IN-CHARGE AT THE SCENE AND WOULD BE CONDUCTED BY STAFF AND RESIDENT VOLUNTEERS TRAINED IN SUCH PROCEDURES ACCORDING TO THE DIASTER MANUAL. Public Notif./Evacuation 04/14/2006 A DETAILED INTERNAL AND EXTERNAL DISASTER PLAN IS IN PLACE. REGULAR DRILLS ARE CONDUCTED INVOLVING ALL STAFF. THE PLAN INCLUDES SPECIFIC PROCEDURES FOR THE NOTIFICATION OF STAFF AND EMERGENCY SERVICES AND FOR EVACUATION IF DEEMED NECESSARY. PER BFD, WE DO NOT MAINTAIN MATERIALS THAT COULD POTENTIALLY REQUIRE EVACUATION OF THE NEIGHBORHOOD. Emergency Medical Plan 04/14/2006 A 24-HOUR SKILLED NURSING FACILITY IS ON SITE. AT LEAST ONE LICENSED NURSE IS ON DUTY AT ALL TIMES. FIRST AID KITS ARE AVAILABLE. TRANSFER TO EMERGENCY ROOM VIA AMBULANCE CAN BE ARRANGED AS NECESSARY. -10- 07/13/2007 .~ ~ J -~. F ROSEWOOD RETIREMENT COMMUNITY I p= Mitigation/Prevent/Abatemt Release Prevention SiteID: 015-021-001058 , Fast Format =, Overall Site =, 09/14/1992 ALL STAFF IS TRAINED IN THE PROPER CARE AND HANDLING OF THE HAZARDOUS MATERIALS THEY MAY ENCOUNTER ON THE JOB. MATERIAL SAFETY DATA SHEETS ARE MAINTAINED AND AVAILABLE FOR REFERENCE BY ALL pTAFF. EMPLOYEE PERFORMANCE EVALUATIONS INCLUDE AN OVERALL SAFETY ELEMENT INCLUDING PROPER HANDLING OF THE MATERIALS FOR WHICH THEY ARE RESPONSIBLE. Release Containment 04/14/2006 LIQUID RELEASES WOULD BE CONFINED BY BARRIER (IE, DIRT BERM FOR DIESEL TANK, COTTON FABRIC FOR CHEMICALS), ABSORBED USING APPROPRIATE DRY MATERIAL, AND DISPOSED OF ACCORDING TO MSDS SPECIFICATIONS. Clean Up 09/14/1992 MATERIAL WOULD BE DISPOSED OF ACCORDING TO MSDS SPECIFICATIONS. Other Resource Activation -11- 07/13/2007 .~ --e-, L~ F ROSEWOOD RETIREMENT COMMUNITY I p= Site Emergency Factors Special Hazards SiteID: 015-021-001058 , Fast Format 9 Overall Site =, Utility Shut-Offs A) GAS - S WALL UTILITY BLDG W OF MAIN DINING RM MARKED ORANGE B) ELECTRICAL - MAIN PANELS NEXT TO GEN IN UTILITY BLDG C) WATER - NEAR NEW STINE ADJ TO SIDEWALK BET ENTRS MARKED YELLOW D) SPECIAL - NONE E) LOCK BOX - NO 01/16/2007 Fire Protec./Avail. Water 01/16/2007 PRIVATE FIRE PROTECTION - ALARM SYSTEM INCLUDING MANUALLY ACTIVATED ALARMS, SMOKE DETECTORS, SPRINKLERS, AND ABC FIRE EXTINGUISHERS. FIRE HYDRANT - 100YDS N OF HIGHRISE BLDG; CRNR NEW STINE RD & SUNDALE; CENTRAL ENTR ON NEW STINE; S ENTR ON NEW STINE; AND 100YDS S OF W ENTR OFF SUNDALE. Building Occupancy Level 04/14/2006 160 EMPLOYEES -12- 07/13/2007 .~.'"' ~" ~c. F ROSEWOOD RETIREMENT COMMUNITY I p= Training Employee Training SiteID: 015-021-001058 , Fast Format =, Overall Site 1 01/16/2007 MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: TRAINING OF ALL STAFF IN THE PROPER CARE AND HANDLING OF HAZARDOUS MATEIALS IS CONDUCTED AT LEAST ANNUALLY. NEW EMPLOYEES ARE ORIENTED TO THESE PROCEDURES DURING THEIR INITIAL PERIOD OF EMPLOYMENT AND STAFF IS INTRODUCED TO PROCEDURES FOR NEW MATERIALS WHEN SUCH IS INTRODUCED TO THE FACILITY. THIS TRAINING IS THE RESPONSIBILITY OF EACH DEPARTMENTS SUPERVISOR AND INCLUDES INSTRUCTION IN THE LOCATION AND USE OF MATERIAL SAFETY DATA SHEETS. Page 2 Held for Future Use Held for Future Use -13- 07/13/2007 LEGEND G ~ Batteries A B C D E F 8 Eye Wash . Fire Extinguisher 14 ft 0 Fire Suppression 1 . First Aid/Survival T . Kit Rectifier ~ Personal Protective 2 Rack Equipment Equip. Equip. Equip, ~ Power Breaker Rack Rack Rack 3 181 Spill Containment 10ft Kit IMSDSI MSDS & 4 Equip, Equip, & CP Contingency Plans Rack Rack 5 :113?Jt SITE Ming Address 1301 New Stine Rd Bakersfield CA 93309 REV. DESCRIPTION BY Drawing 2 (p' j/ BAKERSFIELD FIRE DEPT Prevention Services 900 Truxtun Ave.. Suite 210 Bakersfield. CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 UNIFIED PROGRAM INSPECTION CHECKLIST ~~,"::i'.~m.;1~:.S;i.~~;~,,-:"t~r.:o.Y:;:J.':~i7if' ri~;.lJ.'~(:~~>";~;"i'~.<:,?I:;''.~~-\'!'''5(".- ..n:":~~:t?'i'J1.);:",'~T" :'~k":'_;_ :,:;;'.': ',~:L'.:'!',':.:'.'~_.:J,'; .: _~>M-#",""~':' ,,~ .'~~~~ 'h. t. . '.i,,1"'_",!"~,,5r SECTION 1: Business Plan and Inventory Program . Qe- . V iAAe. j,..~A- 4 0(,;20 SINESS ID NUMBER 15-021- 00 lo5'6' ADDRESS 130\ FACILITY CONTACT ROUTINE Section 1: Business Plan and Inventory Program /) . o COMBINED 0 JOINT AGENCY 0 MULTI-AGENCY 0 COMPLAINT 0 RE-INSPECTION . C V ( C-Compliance) OPERA TION COMMENTS V=Violation -.--.---.- ---------- ~ 0 ApPROPRIATE PERMIT ON HAND ~. 0 Business PLAN CONTACT INFORMATION ACCURATE XD VISIBLE ADDRESS ")( 0 CORRECT OCCUPANCY ~ 0 VERIFICATION OF INVENTORY MATERIALS )I 0 VERIFICATION OF QUANTITIES ~ 0 VERIFICATION OF LOCATION J{ 0 PROPER SEGREGATION OF MATERIAL ~-~------- .. )& 0 VERIFICATION OF MSDS AVAILABILITY 1'f 0 VERIFICATION OF HAZ MAT TRAINING . ~ 0 VERIFICATION OF ABATEMENT SUPPLIES AND . PROCEDURES ~ 0 EMERGENCY PROCEDURES ADEQUATE ~ 0 CONTAINERS PROPERLY LABELED ~ 0 HOUSEKEEPING lS--D FIRE PROTECTION ~ 0 SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: _ DYES XNO . QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 _\ 13' T.,..- fr1 <.../SI,.../liz. cr l- A Inspector (Please Print) Fire Prevention /1" In / Shift of Site/Station # ~ 1J;~ usi ess Site/School Site Responsible Party (Please Print) f2.fA.Y}oA(jY'J V), 1-1 fA,hb-e,J1 White - Prevention Services Yellow - Stalion Copy Pink - Business Copy FD2049 (Rev, 02105) RONALD J. FRAZE FIRE CHIEF Gary Hutton, Senior Deputy Chief Administration 326-3650 Deputy Chief Dean Clason OperationsfTraining 326-3652 Deputy Chief Kirk Blair Fire SafetyIPrevention Services 326-3653 21011H" Street Bakersfield, CA 93301 OFFICE: (661) 326-3941 FAX: (661) 852-2170 RALPH E. HUEY, DIRECTOR , PREVENTION SERVICES FIRE SAFETY SERVICES . ENVIRONMENTAL SERVICES 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 OFFICE: (661) 326-3979 FAX: (661) 852-2171 David Weirather Fire Plans Examiner 326-3706 Howard H. Wines, III Hazardous Materials Specialist 326-3649 November 2, 2005 Ms. Robin Rocca Rosewood Gardens 1301 New Stine Road Bakersfield, CA 93309 RE: High Rise Inspection Dear Ms. Rocca, On Thursday, October 27,2005, a facility inspection was performed. During that inspection it was found that the French fryer in the kitchen area was not properly oriented for coverage by your hood system. This is a very easy fix, and this Department will give you 30 days (November 27, 2005) to correct. Please call me so that a follow-up inspection can be performed and the violation can be signed off. Over-all your facility was a pleasure to inspect. I look forward to hearing from you within the next 30 days. If you have any other questions or concerns, please feel free to contact me at (661) 326-3190. Sincerely, RALPH E. HUEY, Director of Prevention Services )L C~~ By: Steve Underwood Fire Prevention Officer SU:db "Serving tfie Community Por :More 7'fian)t Century" ~- 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 NA~ - INSPECTION DATE INSPECTION TIME ";ri"S'~~-V<<>O.cl-s",_~J we.W'c.d: _Co_""'"t.<~~__" -r-;,~tQ3,-dr~i- __1_32J 1\1 L'-I.l____.l,'--~_~____~_____,_________________ ----~- -----, -------- FACILITY CONTACT Business 10 Number C " 15-021- 0c) I 6S1( Section 1: Business Plan and Inventory Program ~outine n Combined n Joint Agency n Multi-Agency n Complaint ORe-inspection c V ( C=Compliance ) V=Violation OPERATION COMMENTS )If 0 ApPROPRIATE PERMIT ON HAND __~~_,,~~SINE~~LA~~~~~~_~N~~~~~~_~~C~~~~________ ~ n __ VISIBLE ADDRESS - --n:""-"--- - -------" 'feS -- ----ll/t1Jnn ~_mq__~RR-=~:_~_~~U~~~~~________________________ ___ zf 0 VERIFICATION OF INVENTORY MATERIALS Jd' 0 VERIFICATION OF QUANTITIES _____..___.______________________u__._____ n.__._________.____ ..,___ ,........__ __,___.___~___________. __.._.__........________ _.. ..... ____.______n.n ___. ._......__n__ .__ )Zf 0 VERIFICATION OF LOCATION 1!__n ~~~PER ~EG~EGA~~~~~~~TE~~~_____________________ _'_u__m_______,__,_ _ __ .. t..___ n __~=RIFI:~TION OF !:'!_~~~~~~~L~~~~~_=_ _ .______________n._ ___n_____n________nm____ n VERIFICATION OF HAT MAT TRAINING 7f 0 VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES - J!~-- EM~RGENC~- PR;CED~;~--ADEQ~TE----------h------- _,__._________h____________"..._.___n ____nn_______________ -.. ---'''____m______-.______'_'m_____'____'m_'______,,__''_nnn_'-------,--'-----m''''-m'-,4-----,-----,,-- .._.. ",_,______....,_, .mo'____mm' m__ _ _.,_..__,,_ _, ____ __~_,,_~~~~N_E~~ PRO~~~:~~~~:~~_____ __ __________ nu _ --1---- n______ __ _ _____.,u___m___., __ .. __h_ __ _____ o HOUSEKEEPING. 1 !i~~~E P""~~~-=-~~~~:-=-~~~~~=~-=~~-~:~~=-L~Z JZf n SITE DIAGRAM ADEQUATE & ON HAND i ANY HAZARDOUS WASTE ON SITE?: Cl YES )(NO EXPLAIN: or "1enl~ ~1S1~SPEcnON? :'~! ~_T (~;;~9 U _ . ___ J'1J:j Bad,. ~ l~ ......;'~_. ~ leE iron ental Services Yellow. SaliOn Copy Pink . Business Copy ~O--/ CITY OF BAKERSFIEI..D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd [.'Ioor, Bakersfield, CA 93301 /Ie INSPECTION DATE \.2 - O"l.J .. 6 J-. PHONE NO. ~~Lt - oC ~6 BUSINESS ID NO. 15-210- ()~ oS ~ NUMBER OF EMPLOYEES -~ 'I Section 1: Business Plan and Inventory Program 0' Routine D Combined D Joint Agency o Multi-Agency o Complaint D Re-inspection OPERA TION C V COMMENTS Appropriate penn it on hand V" Business plan contact infonnation accurate V Visible address .......'" Correct occupancy ../ Veri fication of inventory materials ./ Verification of quantities 1/ Verification of location 1/ Proper segregation of material Iv' Verification of MSDS availability IV ". Verification of Haz Mat training iV Verification of abatement supplies and procedures Iv' Emergency procedures adequate V / Containers properly labeled Iv Housekeeping IV' Fire Protection Iv Site Diagram Adequate & On Hand v' C=Compliance V=Violation Any hazardous waste on site?: Explain: DYes While - Env, Svcs, Yellow - Station Copy Pink - Business Copy ~2y Inspecto~ .t Questions regarding this inspection? Please call us at (661) 326-3979 1A- - !,! ~~J. 0q 1J~0 VERIZON WIRELESS - MING '0 SiteID: 015-021-003364 Manager : MARK IVERSON Location: 1301 NEW STINE RD (ROOFTOP) City BAKERSFIELD BusPhone: Map : 123 Grid: 03D (661) 664-5601 CommHaz : High FacUnits: 1 AOV: CommCode: BFD STA 07 EPA Numb: SIC Code:4812 DunnBrad:88-463-8305 Emergency Contact MARK IVERSON Business Phone: 24-Hour Phone Pager Phone / Title / OPS MANAGER (661) 664-5601x (661) 203-3205x () x Emergency Contact / Title NETWORK OPERATIONS / CONTROL CENTER Business Phone: (682) 831-3523x 24-Hour Phone (800) 264-6630x Pager Phone () x Period Preparer: Certif'd: ParcelNo: to Fire ImmHlth Phone: (866 ) 694-2415x State: CA Zip 95630 Phone: (866) 694-2415x State: CA Zip 95630 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Hazmat Hazards: Contact : SHAWN STACEY MailAddr: 255 PARKSHORE DR BLDG B City FOLSOM Owner Address . City VERIZON WIRELESS 255 PARKSHORE DR BLDG B FOLSOM Emergency Directives: PROG A - HAZMAT CALL MARK IVERSON, 203-3205, FOR INSPECTIONS. SITE LOCATION: ROOFTOP OF ROSEWOOD RETIREMENT COMMUNITY Based .D,n my ingu,iry of those individuals responsible for obtaining the information, I certify under penalty ot law that I have personally examrned and am familiar with the information submItted and believe the information is true accurate, and COI plete. . ENf'B MA~ S ,007 2,21,07- Date '0.~O\O -1- 02/20/2007 I ~ 1f F VERI40N WIRELESS - MING p= Hazmat Inventory ~ MCP+DailyMax Order SiteID: 015-021-003364 =, By Facility Unit=, Fixed Containers at Site 1 Hazmat Common Name... SpecHaz EPA Hazards DailyMax MCP ELECTRIC STORAGE BATTERY ELECTRIC STORAGE BATTERY F F IH IH S S 2282.40 LBS Hi 552.96 LBS Hi -2- 02/20/2007 '" , "- " -3- 02/20/2007 " " '" F VERI~ON WIRELESS - MING p= Inventory Item 0002 == COMMON NAME / CHEMICAL NAME ELECTRIC STORAGE BATTERY SiteID: 015-021-003364 , Facility Unit: Fixed Containers at Site=, Days On Site 365 Location within this Facility Unit SEALED BATTERY CASE Map: Grid: CAS # STATE - TYPE Solid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE OTHER - SPECIFY Largest Container 95.10 LBS AMOUNTS AT THIS LOCATION Daily Maximum 2282.40 LBS Daily Average 2282.40 LBS ~Wt I ~9.00 Lead HAZARDOUS COMPONENTS ~ CAS # I 7439921 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / Hi f= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME ELECTRIC STORAGE BATTERY Facility Unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit SEALED BATTERY CASE Map: Grid: CAS# STATE - TYPE Solid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE OTHER - SPECIFY Largest Container 23.04 LBS AMOUNTS AT THIS LOCATION Daily Maximum 552.96 LBS Daily Average 552.96 LBS HAZARDOUS COMPONENTS %Wt. RS CAS # 14.00 Sulfuric Acid ( EPA) No 7664939 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / Hi -4- 02/20/2007 " F VERI~ON WIRELESS - MING I p=' Notif, .JEvacuation/Medical Agency Notification - SiteID: 015-021-003364 , Fast Format=, Overall Site =, ,- . Employee Notif./Evacuation Public Notif./Evacuation . Emergency Medical Plan -5- 02/20/2007 c :: } F VERI~ON WIRELESS - MING I f=~Mitigation/Prevent/Abatemt Release Prevention . SiteID: 015-021-003364 =, Fast Format=, Overall Site=, Release Containment Clean Up Other Resource Activation -6- 02/20/2007 -9 T f VERI~ZON WIRELESS - MING I f=~Site Emergency Factors Special Hazards SiteID: 015-021-003364 9 Fast Format=, Overall Site, - - Utility Shut-Offs , Fire Protec. /Avail'. Water Building Occupancy Level 03/09/2006 UNMANNED SITE -7- 02/20/2007 ~ '. ~, .~ r F VER1Z0N .WIRELESS - MING I . p=,~ Training -Employee Training SiteID: 015-021-003364 , Fast Format =, Overall Site =, Page 2 Held for Future Use Held for Future Use -8- 02/20/2007 ...= .~~ .>i Consolidated Contingency Plan for Hazardous 1'1aterials, Hazardous Waste & Underground Storage Tanks Hazardous Materials Division Underground Storage Tanks D D Emergency Coordinator: _,_~..29.9...:,,_~,~~~~~...Qp',~,~~,!,~n~_~~,~!,~~,I,_,~.~,~,!~t...,___.......__..,_,_,_......,___......_, ! Address: 255 Parkshore Drive, Folsom, CA I -'Day';'NOCC-ao-6=2-S4=6S20'C;'r'- ;b;ftei"'lio'urs:'N'OCC"8'6o~26-4=66'2'O' 1,___,_.._.._,_......,PhO~~.~,~:_ ,..~~?,:?~~,:::~~,?_Q_,_...._....,..,....,......_,..,..,_._,...... .....9.E..,~,?.?.:::..?_~~:~~20 _.._.....____,..................._........_.._...., t Responsible for: . sPill~~eventl~,_..._,_____,__,__...__CL_,_..._ Must have the authority to classify the release, make management decisions, & determine appropriate response Person is: D on-site or ~ on-call emergency assessment I 0 (check all that apply) .....managem.ent......,......__........__,..,_......,.._.........._..,_, Initiating alarms 0 g with public emertJCY responders -ag'e'ncy-noHfiCatioii...-....'-..-..-..,......'-'-'-cr----......,........'..............'-.........-'-.....--..'----....---'-........-....-.....0........... Alternate # 1 (INSPECTIONS) Alternate # 2 _,_,_,_...........__,_,__,_,_...._..,..........___,__....,_..,..,..__..,... .. ...,_....(~9.R~~?P.9.!:!..P.~N~,~_!l!:..~!hlJ.,N,G1 Name I Position: Mark Iverson, Operations Shawn Stacey ,JY.Iat:l_~,g_~~_,__,_..__......__............,..,......__.._,_....__ _.._..,..,..,........_....,..,.._......,_..,_,_..............__....,.....................__,_,_.. 255 Parkshore Drive .....................-....-...........--...-............-....--...........................................-........................-.---...........--......-....-....-.....................-................. Folsom ..-..................................................---.........................--."'-.-.--. "'....................-.......-...-.........-....-............-......-..-.................-.............-...................... CA _........._.....M.___......._........__..._...._.......................................__...........................___..............__......_..__._......_................._................._........ 5601 866-694-2415 .-..-....-................----............--...-...-.......................................-....-.....................-..........--..-........................................................ After hours phone: NOCC 800-264-6620 NOCC 800-264-6620 ..,_._._,_._____,___.._,__..._,____.._,_0.._..._............... 9 Address: Alternate Emergency Coordinators: List In order of responsibilit.y, City: Zip: Day phone: On-Site Technical Advisors (Available to provide site..specific technical advice to off-site emergency responders) Person Is: 0 on-site or [gI on-call 0 on-site or [gI on-call ~owner: Supervisor: -'-......:-'..-.............,..-----'-....-..--.--........--..--.........-'-t---~,-,--....,---...---...,-.......,-..-..-..-.....,-..........,--....-......................,..-....-.......................... Manager, I Other, un-staffed facilit I shelter I cabinets Responsi i ities: (attiJch additional pages if needed: indicate an a1tachm(:mt by o checking 1. Refer to the enclosed Haz-Mat Business Plan Additional Information, t lit': txx " Contractor Onyx Special Services '-'aaaress:..'..'....----'-........,..-..-,........-......,-'-'---- Name: responsl i ities: Spill response, clean up, and hazardous material disposal ! ..'fi!lon-e..jj':IlCflf:<!IlIl='790O---'..-----....--..,-'-'-- Call public emergency responders I 911 - 1 - Consolidated Contingency Plan for Hazardous Materials, Hazardous Waste & Underground Storage Tanks Hazardous Materials Division 18 24 Individual responsible for on-site and off-site emergency alarm notifications I communications: Mark Iverson, Operations Manager and/or NOCC - Network o erations Control Center ~ c ec a t at app y: 1::':~~~:I~:~~:mln~~=::,~=:,::=::,=-~:~=::,_,_.. .._~ . ~:~~aadresSOrlnfercom-system''''''''''''''''''''' I~"-'a'iarm"system'---"""'''-'--'''-'--''--'''''''''D''portab'ie-raci'io..--........-...'-....---...........--...."...-..' ~-=3f-~= INTERNAL facility emergency communications or alarm notification will occur via: EXTERNAL notifications I communications to neighboring facilities that may be affected by an off-site release will occur by: o Bakersfield Police Deot. Bakersfield Fire Deot. Kern Medical Center 911 o o o o 661,322,9253 661,324.4542 661,326,2000 o Emergency response phone numbers County Hazardous Materials Division -'polsoii-COiitron::eiifey------'--'----,.......-'-------'----...--..-socr::m=I2:2'2-.-'...----..-'.....-- Nearest medical facility I hospital o Toll Free: 866-372-9378 o 24-HR: 800-300-2193 o RCRA: 800-424-9346 1-800-424-8802 Name: Kern Medical Center Phone #: 661,326,2000 Your medical facility I hospital Phone #: NV: 775-684-2800 o o Agency Notification Phone List o National Response Center Nevada State Fire Marshall NV: 775-684-7500 -1. . Consolidated Contingency Plan Other Important Numbers at acility s eastern border: 30 Business name:, 0 address: , , phone #: ame / position: Business name: , 0 address: , phone #: contact name / position: at. 'acilit.y 5 southern border: at aci ity s western border: -3- Business name: , 0 address: , phone #: contact name / position: Business name: , 0 address: , phone #: contact name / position: Consolipated Contingency Plan Hazardous Materials Division for Hazardous Materials, Hazardous Waste & Underground Storage Tanks 34 35 ~""--provide"'-structurat-PhYSicat"barrier'-(e;g;"portabteT--""~'--'-'-"..~-..._..-_......-,-..---,-..,--.._.....,-.........-..,-..........._..............-...........-......-,-, I 0 spill containment walls) 1181 monitor for leaks, ruptures, pressure build-up, etc 1, containing spills, releases, tires 0 provl(Ie'-aosOroe'i'if'pnyslciiToa'iTier---'-......,-'-.._-' '-O'-cover'oi'"blockJloor-&Tor'5tOrm..'(Irafris..........,..-....,.........-.............., 2. ~~~~~~~~;n:a;d to mi~:~i, I....:~~:::;~::::;.~~:;~::'~~~~=:'=~~~~::::'~:'::=~:: ~~g~~~::;::~,:;'::~~;~~!~~:~:::~~:t:~:;;~::~':::~:=..': property & the envlronn':ent, rl2l-~'" ele~ ~ ,,~.< '"""'~--- ~:~ iQiiPm.it""~~~n.mmiEiOliOi.i~'- I team I (e,g, fuel, propane) F~::~,~.~;:~:~:~:~,:7~~n~~i'~;;~;~:~y~~~;,-....I....g,-,~=~,~~=..~~_~~I,~=...=~_~~I~~~.!.,:~~~~~~'~~~~,~,r.i,~~~~~..,....:....:: l....,_.._.._,~acu~~~on ca~,_...,_.............._,_........_,_..._......_.......,..,_.....___,_,..l_._,_,_...._..,__......,...._..........,__..,.................".._...._.....,........._.............__,_..........,......., 1181 other (specify): Contact Verlzon Wireless 24-Hour Hotline (800-488-7900) and report Incident, which will trigger J Onyx Special Services, I I Indicate your procedures for: Indicate your clean-up procedures: Provide name / position of evacuation I coordinator who will account for all I on-site employees and / or site visitors after evacuation: Identify / describe emergency assembly area for evacuees: Identify the location where your I evacuation route / map is posted: , Other facility evacuation procedures: I ....'~....hlre li'censedhazardo'us-waste'contractor,lONVX-'SpeCiiiTSeiV'iC:esr--..-.......-..--....--......-...----'-'-......-..---............---......-"...--." '-'O..'..u'se'a6soi'bei'if'maierTarfo-r..splllsWTtn'su6sequerifproper-labellng,;,..5torage"ananaiai'douswast-e-o'ispcisafas'--'-,,-,.,... appropriate '-Oslictlo'i'i"usliig-snop,\/a'ciium"wlth"subsequeiifpro'per-laoellng;'5torageaiid'nazardous..'wa5te'i!isposiil"as-'.....,....--',.., appropriate o wash / econtaminate-"'equTp'm'e-rifw/ cc)ntaTnment&disposai-ofeffluenfTriiiSite"ashazardous-waste'-,......,......-.""'..... '-..----..provi'de safete-mporar;'storage'-of"emergency::g-eneratecrwastes"'-'..,-..-...-,-..._......,--...........-,-,-.....-,_...-.......'....,..........,..-,-,-.--..............' Name: un-staffed facility / shelter / cabinets Specify: un-staffed facility / shelter / cabinets Specify: un-staffed facility / shelter / cabinets Specify: -+- Consolidated Contingency Plan Hazardous Materials Division Use Category 43 Fire Extinguishing Equipment Spill Control & Clean- Up Equipment 45 Communications & Alarm System Equipment for Hazardous rVJaterials, Hazardous Waste & Underground Storage Tanks Ex<ll11ple: 3 portable fire extinguishers ..jdieiiikjiriiri)[edivegioves..... ~ c emlca protective suits, aprons or vests -~--CtiemicaIProtectJve g'ioves--'-........'-..........'---..----- '..O...-chemlcaiprotectiVe...-boots......'..'......--....'..'...'-...........-..-.............,-'..............' '~sa'etY9iasses / 9099ies'j'Stiie'ieis........'-......'-'--...'-..-..-..-' ,_~g'-ha~~:~~,~~~==:=,::~~~=-~~~::.~:.~=:::':~::'::':':..'===,=: o cartridge respirator ..O'....seif:conta'ined-iireathlng ci'pparatus-------'----'-----...- ..,~.... f1rst..a'id.i<itSTstii'tioii's......-...----'--..-..'-...........'...........-.................-.......- '-.O..-i>lumbedeyewasii.."ountaln..j"showej.-'-.....--------.........-"... ......~.-portabi'eeyewas'h-kits'--.....-_..................."..,..,--........---.....-..-.- [j--.oth'er:'-.............,.....,-.---.........-----'-'--'----'-'-......---..-, ~ porta e Ire extinguls ers -'O..-fi"Xed'-fire-'systems7sprtiiklers/'f'ire-'iioses-....-.--..,-....,..,-...- "-[j-"'~~~~ar~.~~~_~_~~ ~~~o.~~:"-'-'------,=.:::~~:,:'==::: o other: ~ a 501' ent materia ....,~.....contaiiier'ior..us'ed..ai)scirtient................-'--'-..-.-................,-..---,-..- -..'Oberming'/dii<ii1QequIPm'e'iit----..-'-..-....-....,..-..............,-...,-,-.....-..-. ..."~.-b';.oom'----....-----'--'-.......................-._----'----..............,-...,-.., -..O....'shovej...........'....'--..-'-............-..............--...-..'-............-.....,---.....-..,.., ....O.....sii'op..vac..'-.....-...........-...........'-'-----"-.......'...'........'..........-......,-,-..--,--,--, -..O...exi1allst.tiOO<i..--.......-..----......'-...'.....-.....................'..'--...--..-..,-,...._,-- --0 emergency sump / hoidj'ng-tani<....'....'....'-...-...-...................'..........'-..-'- -~-':~~~~d::~::::::a;~~~~:':::..~..~..:~:,:':'~=-':..-:~:..:~,=:....=..~ o spiii"ove"rpack drums...'-'............------'----.-.....-..-......" - 0 othe'r:-'-'-'-..---,...,-...........,-_..---....-'-.........-,..,-'-,..-..,......, ~ te ep ones inc u es ce u ar "'O""''intercom Tpj..'Sjstem...--...-......................---'--...........'............-....-.- O"-'portable radios--........'..'-.....-...-............' ,...,,-...-,---, ....,.....,-......-.....--,.... -6-automatic- alarm"chem'icai"'monitOrtng equlPment'.........-.......,' OUSTmonitoriiig-systemop'e'ratloiisman-ui!--- ~ list -C;,"notijj'C;ition phoiie..nu'mbEir:s--..----....-..,-'--- center of each wall in shop ...>..,.,.......,...................ms~}.iij..re~;P<)i1se..kif...... .. .mm\ Because each site is an un-staffed facility, shelter or outdoor cabinet, the Operations Cell Tech.lMgr, carries a portable spill kit located in their trucks, Each equipment item marked is contained within the portable spill kit. There is also an additional 5-gallon tub spill kit located within each shelter design facility , Located with the portable spill kit with the Operations Cell Tech.lMgr, Within the portable spill kit. Same as above, Cell phone and #'s with Operations Cell TechJMgr. rated as "(" ."ciiiii:tiiiie..ilse;ci\f&s<llveiii:'resistaiii..... . only One time use & Replaced/Maintained when needed One time use & Replaced/Maintained when needed One time use & Replaced/Maintained when needed 'i Consolidated Contingency Plan for Hazardous Materials, Hazardous Was1:e & Underground Storage Tanks Hazardous Materials Division Identify areas of facility vulnerable to releases I spills due to earthquake related motion: (require immediate isolation and inspection) c ec a I t at app y: location (e,g. shop, outdoor shed, Forensic lab): "'-~-liaZar'd'ous'materlalsI'waSte'-'sji)rage"'area"-'--"-'"-.....--...-'......-.....-'--'-......'-...-...'......'....-..-......'--'-........--........--......,...-,...-..---.....-,...... O....processiTnes'Tpjping............'---'-..--.........-,..,-'-'-'-'-'--,..,---.., Batteries installed exceed 1997 UBC ,-----.........--..........-..--..-,-..-,...-,-..-......,--,--....,--..... and/or 2000-20031BC Seismic Zone 4 ..._l:;:J_~~~~~~,~.............,_..._"_..__......_.........._......,'_........_,_....___ specifications, o waste treatment area C lee a I t lal app y: A ecte( ocalions: 49 Identify mechanical systems vulnerable to releases I spills due to earthquake related motion: (require immediate isolation and inspection) ,~~Q::::~~~I~~~ca~~~~~.~~~~c~::':::~=~==::=:=::::==_=: ----,..--,-,-..-........" .._,Q,~~~....(,~,~,~~~~~..,~,~_u~~~....................................,______..._..... ...,Q.!~~,~~,~..=~~I,I,~,~,~,~.................................._,-_...__.......__......... ..,_~...:mergen::...~hutOff ~~~,~,~~~~~~ves .........,_....__..._,_..__,_, \ 0 sprinkler systems ........--.---.-.....-.....--..---.--.........-......-.-.--.........-...-----........--.....-.-. I 0 stationery pressurized containers (e,g, tank for dispensing propane) Power Breaker Located on/at un- staffed facility, shelter or outdoor cabinet. Advance arrangements with locai fire & police departments, hospitals and lor contractors or emergency services should be made as appropriate for your facility; you may determine that advance arrangements are not necessary for your facility. Describe any advance arrangements made for local emergency services: ~D Determine not necessary --......"........".........".......-............-.......-..-....................----.--..............-....--........-....."..------...-.............................--..........................----......---.........-.....-..-...........-..................................... ~ Specify: ONYX Is available 24 hours per day to assist In spill clean up, and/or telephone support regarding spills i or venting of batteries, 53 ~'tpjit@,t!Q.l)_.Q.t~.q"'jf,e..m~.!!! Clean-up operations including volunteers &lor contractors, Required content for employee training includes all of the foilowing: 54 . communication & alarm systems personal protective equipment (e,g. use of emergency response equipm~:nt fire extinguishers! respirators! etc) . Material Safety Data Sheets hazard communication related to health & safety methods for safe handling of hazardous substances fire hazar(js of materials I processes conditions likely to worsen emergencies coordination of emergency response notification procedures applicable laws & re[)ulations . . I · I I · I . I I : . . . decontamination procedures evacuation procedures . equipment & . Indicate how employee training program (with required content) is administered: check all that apply: :-:....':;::7::~~~eetin;::~:::::::=:r:~::::~~~~::;,~~n~~~~~~~':..~~~~;n~:=~~~~=:::,=:'=,::~=::::=::::::=:::':'::,:=,:,......, ..O-Study..Guid'esTManuafs-{specityf...'-'-'-.....,-----...,..,--"-,....-..--.-..-..........--..-,-,-........--..,-..,------..,--.....---,-...........-.....-, ~ 6 - .. " , , Consolidated Contingency Plan for Hazardous Materials, Hazardous Wa~1:e & Underground Storage Tanks 58 ~~pjMl~.tjQXLQ.U~..qyjnmf-J!t Emp oyee training mu~1: e: . provided within 6 months for new hires, . amended as necessary prior to change in process or work assignment, . given upon modification to emergency response I contingency plan, and . updated I refreshed annually for ALL employees. 59 Certify that the facility's employee training program meets minimum fre uen re uirements: I ~ Employee training Is provided, at a minimum, as described above, 60 61 ~~pJpJ)illjpJ:'-.Q.L~..q!Jjr,~mf-J!! Written documentation of employee training sessions must be kept which include: . training outline j agenda employee names &. job titles . . date of training session brief job descript.ion for hazardous waste generat.or facilities . Certify that the facility's training I documentation meets minimum record 181 Employee training documentation Is provided, at a minimum, as described above, kee in re uirements: Training program description or outline ...._r:;:.l,.....,!;m.I1I.Qy.gUi!.LI).!D.g..P..r.Q9r.!!m,.Q!.!.t!,!n.ejs...i!!;tg,~hgd-'-_....____....,_...........,.......,_,.....__,__......,....,_........,_...,.....'.........._....'__................_.............. attached: ~ Employee training program Is described here: I The Verizon Wireless Operations Managers make sure that their Field Operation Staff, depending on their position, are trained in the applicable topics located in the Environmental Health Safety Awareness Training Overview at the date of hire, There is also annual online training with TargetSafety,com performed in Hazardous Communications, Combustible & Flammable Liquids, Eye Safety, and Personal Protective Equipment. Attached is the following: o Verizon Wireless Additional Information for SPILL PREVENTION, EMERGENCY RESPONSE, TRAINING and CLOSURE PLAN o VZW Environmental Health Safety Awareness Training Overview o VZW Network Training Matrix that gives the training topic and frequency of training, o TargetSafety,com training objectives, table of contents, and a list of staff that have completed the online annual trainin , Environmental Compliance -7- ,)lSTRICT FACILITY ADDRESS FACILITY NAME BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 0 Fax: (661) 852-2171 ffO -It q3. p OCC TYPE BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS RISER DATE CORRECT ALL VIOLATIONS VIOLATION CHECKED BELOW NO, COMBUSTIBLE WASTE / DRY -~- .' ~VEGET,6,'!'ION-<-- 2. COMBUSTIBLE STORAGE 3 EXTINGUISHERS SIGNS FIRE DOORS / FIRE SEPARATIONS EXITS STORAGE ELECTRICAL APPLI OUTDOOR BURNING FIREWORKS OTHER CUSTOMER: INSPECTo.R: " 'L:~'''~.r-,..i ... ... "'f'" ~ .,n, "~. ., ._$<""--'~- ;:-, :_~~':,"'- , " CITY, STATE, ZIP, BILLING PHONE NO,. OCC LOAD NO, OF FLOORS HIGH RISE BLDG DYES 0 NO REQUIREMENTS Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U,F,C,) -- - - ProvIde noft-combustible containers with tight fitting lids for the storage of combustible waste and rubbish pending its safe disposal. (U,F,C.) Relocate combustible storage to provide at least 3 feet clearance around motor fuse boxlfire door (N,E.C,) (U,F ,C:r-- 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) 5 Provide and install (amount) _ approved (type & size) __________ portable fire extinguisher to be immediately accessible for use in (area) _ (U.F,C,) '~ 6 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.) Provide and maintain 'EXIT" sign(s) with letters 5 or more inches in height over each required exit (doorlwindow) to fire escape. (U,F.e.) 7 8 Provide and maintain appropriate numbers on a contra ,correct address of the building. (B.M,e,) (U.F.e.) the street to indicate the . tJ ~ !Sito 9 Repair all (cracks/holes/openings) in plaster in (location) _______________________' Plastering shall return the surface to its original tire resistive condition, (U,B,e,) , Remove/repair (item & location) __________________~______________________. Self-closing. doors shall be designed to close by gravity, or by the action of a mechanical device, or by an approved smoke and heat sensitive device, Self-closing doors shall have no attachments capable of preventing the operation of the closing device. (U,F,e,) Remove all obstruction from hallways. Maintain all means of egress free of any storage, (U.F,C,) .;~ 10 11 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,e,) . Remove all storage and/or other obstructions from fire escape landings and stairways stair shafts, (Fire escapes/stair shafts are to be maintained free, from obstructions at alrtimes.) (U,F,e.) ,t, ,/'1 ;.,:;" 13 <i' q; --14 ~ ~s~t~on cord_s~sh~U.l!Q.U~e used7Ul,J~lLQ.!..p_erm~,llent.J!PIHoved.Jtirlng. Install additional appr.oved_electr.icaLoutlels.c where needed. (N,E.e.) (U;F,e,)' ' 15 16 17 Remove multiple attachment cords from specific electrical convenience outlet (one plug per outlet) (N,E,C.) (U,F,e,) ':Th fireworks,'- ,~!{ ;~.:i ::,~ . ,~?: . "';;i .,'.~' "~'-. ,~ " (Please Print Name Legibly, Title) , '-, "AP NO.: f LEGEND: C.F.C.' U,B.C. B,M.C.' N,F.P.A. CALIFORNIA FIRE CODE UNIFORM BUILDING CODe . ; -J BAKERSFIELD MUNICIPAL CODE -,-", ij: NATIONAL FIRE PROTECTION'l",; , , ASSOCIATION ' ". HAT....... ELECTRIC CO.~_:;.'!J~ . ~..t~. N,E.C. , , White - Customer/Original', :;'~~;~-"~': " 1:. ,,:,~:,,<,:":'~'. Yellow - Stalion Copr "" Pink - Prevention Services Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME ____L!u_lU2Q__W_LL{...J.~_SS------.- _________ ADDRESS ____-1-~~<;b~_1LL________ FACllITYCONTACT e~ - I INSPECTION DATE INSPECTION TIME -.--------- ---.--------- - t;;~~~:{,~~:i'.1.'" ------ -- -- ~- -- ~------- BuslnesslDNumoor - - - --- 15-021- 00 3:S'4 Section 1: Business Plan and Inventory Program ~ Routine C'J Combined Cl Joint Agency Cl Multi-Agency Cl Complaint Cl Re-inspection c V (c=comPlianee ) V=Violation OPERATION COMMENTS i._~__Ap~RO~~~~~~E~~~~~~~!~___ ____.______________u___ _ _._ _,______ ..____________., ___.___. _____ JZI 0 BUSINESS PLAN CONTACT INFORMATION ACCURATE -----------------.----.------.-.-- ------...--. ."--- .-.--- ~ Cl. VISIBLE ADDRESS ---'-----"-:------------'---------,,-------------'_._------ -- r:t Cl CORRECT OCCUPANCY _" __'__________________.___________,____u_.__,____ _ _, _,___ __,_..___,________ r;1 C'J VERIFICATION OF INVENTORY MATERIALS _________________________,_..._______m____'.__,___,____. .tJ Cl VERIFICATION OF QUANTITIES , ._,--- _ _,f_)!~~~L(~~_t __s<_fy/!~~_ ENT'D _m___' ------------- --ND-V-2-9'ZaD6-- . r) 0 VERIFICATION OF LOCATION .________,_____._______ :t____Cl _~~~PER ~EG~EG~~~~~~~~~~~~:______________________. _______________._.m u __ _ _2___ Cl___~=~~:~T10N OF ~,~~~_~~~~~~~~_=_________u..,____ ___.___________._.___ .___._______________ % Cl VERIFICATION OF HAT MAT TRAINING c---~-----'''---______'_______u______'_u__'_ _u,_,____,_u _____ c-'------------ --. ____,,____,______, _ _ m__.____,.__ 2f Cl VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES , _________________ _______'_._~m__'_'_______m"_ ,____m _____.______...____u_____"_"m _________u__ ___'''_''_un ________,_____ ,___.______,,___ _, _n_u____ __" J2f 0 EMERGENCY PROCEDURES ADEQUATE ---'-'________________'m'__m___.__u,"_m______,_____",__"",,_______,__,__ __m_______"_~-----..-----,,--,,-, _ ,,_,,___________, ,_u ",,___n_ __ __ _ p Cl CONTAINERS PROPERLY LABELED I _______..__,____u_____ _,,_____.___,__ __n ______ _", m_a ___,,__ _,,,_____ "''''' _u~-,,-..-- ______,____ __ __ _____________ __ '__m u_ _ _ _ _ '" _.m_ yt 0 HOUSEKEEPING, j r-- _____________m______.,,______.un____u___________ "'_ ______,___ u__ ___,___'_____m__"_'_u____ ",__ ___,____'_______m__'_'_ yr 0 FIRE PROTECTION -----,-----------------.. _____..______.___.__.._..__~.__.__________.._______n_ ___.__ __.0__'__ _..__________.__ ___'U_". ___ ___._._..___._____... __ . ._. ._.____.. _.. ._ rj Cl SITE DIAGRAM ADEQUATE & ON HAND I ANY HAZARDOUS WASTE ON SITE?: Cl YES ANO EXPLAIN: . , QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 _'_A ~' #/0 1A peetor ---------------------8;dge N~~..----'--- ?P ,j/ ~J' ._--~._._,-_._------_._.._-----_._,.._~- Business Site Responsible Party White - Environmental Services Yellow - Slallon Copy Pink . Business Copy -~ !.:t:~ "':..;~ ri VERIZON WIRELESS - MING SiteID: 015-021-003364 Manager MARK IVERSON Location: 1301 NEW STINE RD (ROOFTOP) City BAKERSFIELD BusPhone: Map : 123 Grid: 03D (661) 664-5601 CommHaz : High FacUnits: 1 AOV: CommCode: BFD STA 07 EPA Numb: SIC Code:4812 DunnBrad:88-463-8305 Emergency Contact MARK IVERSON Business Phone: 24-Hour phone Pager Phone / Title / OPS MANAGER (661) 664-5601x (661) 203-3205x () x Emergency Contact / Title NETWORK OPERATIONS / CONTROL CENTER Business Phone: (682) 831-3523x 24-Hour Phone (800) 264-~ Pager Phone () -~~zDX Period Preparer: Certif'd: ParcelNo: to Fire ImmHlth Phone: (866) 694-2415x State: CA Zip 95630 Phone: (866) 694-2415x State: CA Zip 95630 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Hazmat Hazards: Contact : SHAWN STACEY MailAddr: 255 PARKSHORE DR BLDG B City FOLSOM Owner Address City VERIZON WIRELESS 255 PARKSHORE DR BLDG B FOLSOM Emergency Directives: PROG A - HAZMAT ENrD JUL 3 0 2007 CALL MARK IVERSON, 203-3205, FOR INSPECTIONS. SITE LOCATION: ROOFTOP OF ROSEWOOD RETIREMENT COMMUNITY [''''''cd on m\l ir.quiry 0' th ' re3r"':-'~it,l., fo'r'Ob't, ' , .' I.' Ose Individuals ,. .". ,,' ~'n''-'', the 'nfo " unfle~' penalty Gtia:,~ "that', h~~~dOn,! cortify examined and am f l ,'~ per_onally ~~~; lt~~~~~o~~;:Yi' ;~~ ~i~r~~ti~~O;~frt~~~ ;hd7 -1- 07/16/2007 f 3' .......::.. ~ F VERIZON WIRELESS - MING p= Hazmat Inventory f== MCP+DailyMax Order SiteID: 015-021-003364 By Facility Unit Fixed Containers at Site =, , =, DailyMax IUnitlMCP 2282.40 LBS Hi 552.96 LBS Hi Hazmat Common Name... IspecHazlEPA F F Hazards \ Frm I ELECTRIC STORAGE BATTERY ELECTRIC STORAGE BATTERY IH IH S S -2- 07/16/2007 ::... ~ "il -3- 07/16/2007 ~ ~ F VERIZON WIRELESS - MING f= Inventory Item 0002 = COMMON NAME / CHEMICAL NAME ELECTRIC STORAGE BATTERY SiteID: 015-021-003364 , Facility Unit: Fixed containers at Site ~ Days On Site 365 Location within this Facility Unit SEALED BATTERY CASE Map: Grid: CAS # STATE - TYPE Solid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE OTHER - SPECIFY Largest Container 95.10 LBS AMOUNTS AT THIS LOCATION Daily Maximum 2282.40 LBS Daily Average 2282.40 LBS HAZARDOUS COMPONENTS I~ CAS # I 7439921 ~Wt I ;9.00 Lead HA A N TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / Hi ZARD SSESSME TS p= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME ELECTRIC STORAGE BATTERY Facility Unit: Fixed Containers at Site, Days On Site 365 Location within this Facility Unit SEALED BATTERY CASE Map: Grid: CAS # STATE - TYPE Solid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE OTHER - SPECIFY Largest Container 23.04 LBS AMOUNTS AT THIS LOCATION Daily Maximum 552.96 LBS Daily Average 552.96 LBS N %Wt. RS CAS # 14.00 Sulfuric Acid ( EPA) No 7664939 HAZARDOUS COMPO ENTS AS MENT TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / Hi HAZARD SESS S -4- 07/16/2007 .!' ~~, ~ c. ' SiteID: 015-021-003364 , Fas t Format 9 Overall Site=, 03/12/2007 F VERIZON WIRELESS - MING I p= Notif./Evacuation/Medical Agency Notification PHONE 800-621-2622 AFTER NORMAL BUSINESS HOURS, LOCAL PERSON IN BE NOTIFIED AND WILL RESPOND. SITE SHOULD BE IDENTIFIED BY SITE DURING REGULAR HOURS, USE CONTACT NUMBERS PROVIDED IN SECTION 2: NOTIFICATION. CHARGE WILL NUMBER. EMERGENCY Employee Notif./Evacuation Public Notif./Evacuation Emergency Medical Plan -5- 07/16/2007 i--. . ;. SiteID: 015-021-003364 , Fast Format=, Overall Site =, 03/12/2007 F VERIZON WIRELESS - MING I p= Mitigation/Prevent/Abatemt Release Prevention BATTERIES ARE LOCATED INSIDE LOCKED COMMUNICATIONS SHELTER AND ARE MONITORED 24-HRS PER DAY BY THE LOCAL SWITCHING STATION. INSPECTED ONCE PER MONTH BY SITE TECH. Release Containment Clean Up 03/12/2007 INTERNATIONAL TECHNOLOGY CO 800-262-1900 Other Resource Activation -6- 07/16/2007 -- '!'\, '. I,.. r F VERIZON WIRELESS - MING I p= Site Emergency Factors Special Hazards SiteID: 015-021-003364 , Fast Format =, Overall Site=, Utility Shut-Offs 03/12/2007 ELECTRICAL - E SIDE OF BLDG Fire Protec./Avail. Water 03/12/2007 1 HALON 1211 FIRE EXT (9 LBS) L SIDE OF ENTR DOORS. Building Occupancy Level 03/09/2006 UNMANNED SITE -7- 07/16/2007 .._.~} ..r'> .;~ ., F VERIZON WIRELESS - MING I p= Training Employee Training SiteID: 015-021-003364 , Fast Format=, Overall Site =, 03/12/2007 MSDS SHEETS ON FILE. Page 2 Held for Future Use Held for Future Use -8- 07/16/2007 ~~,--- ~_ 1-......:; + VERIZON WIRELESS -MING ============================= SiteID: 015-021-003364 + Manager ALAN HOLZMAN Location: 1301 NEW STINE RD City BAKERSFIELD BusPhone: Map : 123 Grid: 03D (661) 873-2401 CommHaz : High FacUnits:1 AOV: CommCode: BFD STA 07 SIC Code:4812 ~ III_~ o~ EPA Numb: DunnBrad: Q,l 2"1.6 11J98~-"'\Q.,J-oo +==============================================================================+ +=========================::============+======================================+ Emergency Contact / Title Emergency Contact / Title ALAN HOLZMAN / NET OPER MGR RUSS WALKER / OPERATIONS TECH Business Phone: (661) 873-2401x Business Phone: (661) 747-7001x 24-Hour Phone : (661) 87.2-2662x 24-Hour Phone : (661) 321-5214x Pager Phone : () x Pager phone .: () X +---------------------------------------+--------------------------------------+ I Hazmat Hazards: Fire ImmHlth I +------------------------------------------------------------------------------+ Contact: SHAWN STACEY Phone: (916) 3S7-252~ MailAddr: 255 PARKSHORE DR l State: CA t!l,~ l.Itil/ Z'lI5"' City : FOLSOM Zip : 95630 +--------------------------------~---------------------------------------------+ Owner VERIZON WIRE ES~ Phone: (925) 279-6455x Address : 2785 LL DR State: C City T CREEK 5a0\.€. 94598 +------ -----------------------------------------------------------------------+ Period to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: +---------------------------------~-------------------------------------------+ Emergency Directives, ~~ll FROG A - HAZMAT I'} 1 EN 7IJ JUt 1 8 200S Based ,on my inquiry of those individuals responsible for obtaining the information. I certify under penalty of law that I have personally examl.Md an am familiar with the information submItted an believe the infor atlon is true ccurate, and mplete. f ~t^Q\O ~ st:fP o~ +==========================:===================================================+ -1- 03/09/2006 ~ ""...:; .~....:...#,.~."t ..~ Jri:"~-_- .../"' Bakersfield Fire Dept. --ONIFIED PROGRAM INSPECTION CHECKLIST Enironmental Services 1715 Chester Ave SECTION 1 Business Plan and Inventory Program Bakersfield, CA 93301 . Tel: (661)326-3979 FACILITY NAME. _ r1 ! INSPECTION DATE INSPECTION TIME ADDREssj)~!.2.tl~_----LLlL~-L~s..s-~r-l-!!\-~-- - --- ---- _n ------- ------ ~oi~--:--~-~- No-OiEmployees-- _______J'30' ~ ~ __Sh~___~-=--___ ______ ________ __n________ ~___ ___ ~ __ - - __ __ _n___ -- FACllITYCONTACT Business 10 Number 15-021-ex? 33G4 Section 1: Business Plan and Inventory Program Routine D Combined DJoint Agency D Multi-Agency D Complaint D Re-inspection C V ( C=Compliance ) V=Violation OPERATION COMMENTS .' ~_ :_~;~:~::e:~~~~~MA;~:;c;~ENlijNQV~i~zrioil1~?I'l,,-n- - D D VISIBLE ADDRESS C1~_ CORReCT -"-ccuPAt<C."-~_.,"'_______ ., - '7-; ",,,,-'1_,, ifJ.' ., - ~" VeR'":,,,ON OF 'NVENTORY_....,."..IAlS_,_______ .... . "')-IJ!'...- 'C;\J?J.,...-. _ ....... "",. .." . '~~..s~::~~:s~~~~~=~=._"',. ~~=.~~~..~_~~.~..".f~-~D, . '-..--.-'---'-'" -~_~}~~~~~~~~~~t~-~~~-__=~mLt;-~~~~~..~=~n~,-_q '--.....,. '< -~--~=-:::S:~~::~~~~TE&~.-HAN~ _=..= :~t-=:...~ _._m_ n:_~..m_:~=~:: ~,~ Ru7S -700 / I A1 / ANY HAZARDOUS WASTE ON SITE?: DYES D No _ . . rw1 . U EXP~'N ~~ ~ ~LV . QUESTIONS RE RDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 _hmn __~/12________1A Badge No" Business Site Responsible Party While . Environmental Services Yellow - Slation Copy Pink . Business Copy