HomeMy WebLinkAboutBUSINESS PLAN (2)II' j
'I ~ i CEN't'RAT. NEPHRO~.OGY MED GRP INC
5030 OFFICE PARR DRIVE
Ti ;1
+ CENTRAL NEPHROLOGY MEDICAL GRP ______________________ SiteID: 015-021-002255 +
Manager HAROLD J BAER MD
Location: 5030 OFFICE PARK DR
City BAKERSFIELD
CommCode: BFD STA 11
EPA Numb:
BusPhone: (661) 323-2847
Map 102 CommHaz Low
Grid: 34B FacUnits: 1 AOV:
SIC Code:
DunnBrad:
Emer_gencv_Conta_ct / Title Emergency Contact / Title
Cyc~r~-`~ ~c;~+^6Ac:-ire / OFFICE MANAGER STEVE REESE / CHIEF TECH
Business Phone: (661) 32.3-2847x Business Phone: (661) 316-1126x
24-Hour Phone (661) 316--1ia!(o 24-Hour Phone (661) 396-1715x
Pager Phone (661) ~;-„~~~,. Pager Phone (661) 398-6875x
Hazmat Hazards: DelHlth
Contact PAUL ASUNCION Phone: (661) 323-2847x
MailAddr: 5030 OFFICE PARK DR State: CA
City BAKERSFIELD Zip 93309
Owner CENTRAL NEPHROLOGY MED GRP INC Phone: (661) 323-2847x
Address 5030 OFFICE PARR DR State: CA
City BAKERSFIELD Zip 93309
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
Emergency Directives:
PROG H - HAZ WASTE GEN ~~
~~
/ /~
V ~`
Based on my inquiry of those individuals
responsible for obtaining the information, I certify (~~
under penalty of law that I have personally ~ J
examined and am familiar with the information
submitted and believe the information is true,
accurate, and complete.
~ I ,~lo ~
Signature~~,~~ ~ Date R
~~~4~ ~ ~ ~ ~ ~ ~ ~ V
-1- 05/12/2006
+ CENTRAL NEPHROLOGY MEDICAL GRP ______________________ SiteID: 015-021-002255 +
Manager HAROLD J BAER MD
Location: 5030 OFFICE PARI^~ DR
City BAKERSFIELD
BusPhone: (661) 323-2847
Map 102 CommHaz Low
Grid: 34B FacUnits: 1 AOV:
CommCode: BFD STA 11 SIC Code:
EPA Numb: DunnBrad:
L
F
Y _______________________________________
I.
~~1~4.
1~ _~
~/ ______________ _
Emerg ncy Contact / Title Emergency Contact / Title
/ OFFICE MANAGER STEVE REESE / CHIEF TECH
Business Phone: (661) 32.3-2847x Business Phone: (661) 316-1126x
_"_ -_ =__ _______ (661) 31~, "-_~~- 24-Hour Phone (661) 396-1715x
Pager Phone ( 6 61) •-i ~~ -a-= s-'~~ Pager Phone ( 6 61) 3 9 8 - 6 8 7 5x
Hazmat Hazards: DelHlth
Contact PAUL ASUNCION Phone: (661) 323-2847x
MailAddr: 5030 OFFICE PARK DR State: CA
City BAKERSFIELD Zip 93309
Owner CENTRAL NEPHROLOGY MED GRP INC Phone: (661) 323-2847x
Address 5030 OFFICE PARK DR State: CA
City BAKERSFIELD Zip 93309
Period to TotalASTs: = Gal
Preparers TotalUSTs: _ ~ Gal
Certif ' d: RSs : No
~n
ParcelNo : '
'
-
----------------------------- ------------------------------
Emergency Directives: ~,~
PROG H - HAZ 'G~A~"1'~~~E N ~ ` ~ ~^S~~ ~~®O
'
~
~~y C t3 1 ~.~- s ~-~
~; ~ S~ti i -- ~ ~ ,z2 c n. S @- s ~--b o ~---~ ~,S ~ ~ a ~Z.~r1 ~: J
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f /,j1.1 O G ~i. ,j 1.~ `1.~ ~ f 1 O~ /t.- L C11._S L ~, ~ '~--~ f ''~ 'f -~'~ ~.~ ~ S
-1- 05/12/2006
+ CENTRAL NEPHROLOGY MEDICAL GRP ______________________ SiteID: 015-021-002255 +
+= Hazmat Inventory _________________________________________ By Facility Unit +
+_= MCP+DailyMax Order ______________________________ Fixed Containers at Site +
Hazmat Common Name.., ~SpecHaz~EPA Hazards Frm ~ DailyMax ~Unit~MCP~
~ LABORATORY WASTE CHEMICAL DH L 2.00 L UnR~
-2- 05/12/2006
-3- 05/12/2006
+ CENTRAL NEPHROLOGY MEDICAL GRP ______________________ SiteID: 015-021-002255 +
+= Inventory Item 0001 _______________ Facility Unit: Fixed Containers at Site +
+_= COMMON NAME / CHEMICAL I+~AME ______________________________+________________+
LABORATORY WASTE CHEMICAL I Days On Site
` 365
Location within this Facility Unit Map: Grid: +----------------+
~ CAS# ~
+= STATE _+= TYPE ___+_= PRESSURE ___+ TEMPERATURE __+___= CONTAINER TYPE _____+
Liquid ~ Waste ~ Ambient ~ Ambient ~ DRUM/BARREL-METALLIC
+__________________________+ AMOUNTS AT THIS LOCATION =___________=____________+
Largest Container I Daily Maximum I Daily Average
20.00 L 2.00 L 1.00 L
+_______+______________ HAZARDOUS COMPONENTS =_____________+___+_______________+
%Wt. I ~ RSI CAS#
+_______+___+______+___=______= HAZARD ASSESSMENTS =__+_______=_+_____=__+_____+
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No INo I No I Noj Curies I DH ( j / / I I UnR
-4- 05/12/2006
' r.
+ CENTRAL NEPHROLOGY MEDICAL GRP ______________________ SiteID: 015-021-002255 +
+_________________________________________________________________ Fast Format +
+= Notif./Evacuation/Medical ____________________________________ Overall Site +
+_= Agency Notification ___________________________________________ 04/03/2003 +
911 CALLED IMMEDIATELY IN THE EVENT OF FIRE OR OTHER DISASTER
+__= Employee Notif./Evacuation ___________________________________ 08/15/2003 +
OVERHEAD PAGE TO ALERT THE STAFF EXAMPLE "CODE RED" AND DISASTER LOCATION OF
FIRE.
DIAL 911 TO GIVE LOCATION & ADDRESS OF BUILDING AND EXTEND OF FIRE OR
EMERGENCY.
RECEPTIONIST WILL TAKE DISASTER BAG TO THE EVACUATION AREA.
MEDICAL ASSISTANT WILL ESCORT PATIENTS FROM FACILITY TO EVACUATION AREA.
LAB STAFF HELP EVACUATE PAIENTS.
OFFICE MANAGER IN CHARGE OF EVACUATION AREA WILL PROVIDE LINK BETWEEN MD AND
STAFF.
*______________________________________________________________________________t
+___= Public Notif./Evacuation =_______________________________________________+
V~~~~1
+____= Emergency Medical Plan _____________________________________ 05/12/2006 +
OTHER THAN OUR OWN MEDICAL OFFICE FACILITY, MERCY HOSPITAL, 2215 TRUXTUN
AVE, 632-5275.
-5- 05/12/2006
+ CENTRAL NEPHROLOGY MEDICAL GRP ______________________ SiteID: 015-021-002255 +
+_________________________________________________________________ Fast Format +
+= Mitigation/Prevent/Abatemt ___________________________________ Overall Site +
+_= Release Prevention ____________________________________________ 05/12/2006 +
LABORATORY WASH FROM ANALYSIS IS KEPT IN A STORAGE CONTAINER AND IS DUMPED
DAILY IN THE LABORATORY SINK. LAB EMPLOYEE ARE PROVIDED LAB COATS AND
GLOVES WHENEVER WORKING TN THE LAB AND/OR OBTAINING SAMPLER FROM PATIENTS.
BIO CONTAINERS (RED BAY TRASH CONTAINERS AND STORAGE CONTAINERS) ARE LOCATED
THROUGHOUT THE FACILITY II~T CLOSE PROXMINITY WHERE THEY. MIGHT BE NEEDED.
BIOHAZARD MATERIAL IS KEPT IN A 30-GAL RECEPTACLE AND IS PICKED UP ONCE A
WEEK BY CALIFORNIA MEDICAL DISPOSAL INC.
+__= Release Containment __________________________________________ 05/12/2006 +
SPILL KIT FOR BIOHAZARD SPILLS. BIOHAZARD WASTE PICKED UP WEEKLY BY
CALIFORNIA MEDICAL DISPOSAL INC. STERICYCLE ANALYZER WASTE DUMPED DAILY IN
LAB SINK.
+___= Clean Up ___________________________________________________= 04/03/2003 +
RE-STOCK SPILL KIT SUPPLIES.
+____= Other Resource Actiuation ______________________________________________+
-6- 05/12/2006
a
+ CENTRAL NEPHROLOGY MEDICAL GRP ______________________ SiteID: 015-021-002255 +
+_________________________________________________________________ Fast Format +
+= Site Emergency Factors _______________________________________ Overall Site +
+_= Special Hazards ______________________________ +
+__= Utility Shut-Offs ________________________________________________________+
+___= Fire Protec./Avail. T~later _______________________________________________+
~c f ~
t______________________________________________________________________________t
+=___= Building Occupancy Level ___________________________________ 05/12/2006 +
11 EMPLOYEES
-7- 05/12/2006
~- n
+ CENTRAL NEPHROLOGY MEDICAL GRP ______________________ SiteID: 015-021-002255 +
+_________________________________________________________________ Fast Format +
+= Training _______________ ------------ Overall Site +
+_= Employee Training _____________________________________________ 05/12/2006 +
MSDS SHEET ON FILE.
BRIEF SUMMARY OF TRAINING PROGRAM: SAFETY ISSUES ARE COVERED PERIODICALLY
AT OFFICE STAFF MEETINGS.
+__= Page 2 ___________________________________________________________________±
+___= Held for Future Use _____________________________________________________+
+______________________________________________________________________________t
+____= Held for Future Use ____________________________________________________+
-8- 05/12/2006
+ CENTRAL NEPHROLOGY MEDICAL GRP ______________________ SiteID: 015-021-002255 +
+= Full Format ___________________ Type+Category+Sub-Category+Date2(ASC) Order +
+____________________________________________________________ One Unified List +
+________________________________ INSPECTIONS =_____________=__________________+
(BUSINESS PLAN PROGRAM ROUTINE INSPECTION
Reference Dates Summary Description
WINES 12/04/2001 OKAY
-9- 05/12/2006
;.,~:-' Prevention Services
UNIFIE~"~R~GRAM INSPECTION CHECKLIST'' a A: R s ~ , n 900Truxtun Ave., Suite 210
..~:;.._~.. .:~..._~..::~.,a.~~_ ,mom ~,~..~.~..~~~ .....~~.. ~.~.._., _....~~F.._~.~._ _:~r.~ ~- -FIRE Bakersfield, CA 93301
SECTION 1: Business Pfan and Inventory Program ~ "'~'"' Tel,: (661) 326-3979
_ Fax: (661) 872-2171
-""i
FACILITY NAME
CE.~r& `. ~ G~ rtQdGO4~ INSPEC IONpATE
~, a INSPECTION TIME
ADDRESS
SO 3a ~1 CG pp~t D~ PHONE NO. uu
3~ --Z,~'1 NO OF EMPLOYEES
J~
FACILITY CONTACT BUSINESS ID NUMBER
~ ~ a ~ ~ L ~~~ t ti `Q 15-021-CIS - D ZI - ~ 2ZS5
I
Section 1: Business Plan and Inventory Program- ~
_ _ I
- -- -- _~ _ ,_ -- --__ - i
^ ROUTINE ® COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION
C V ( C=Compliance OPERATION
V=Violation COMMENTS
^ APPROPRIATE PERMIT ON HAND
^ BUSIfIeSS PLAN CONTACT INFORMATION ACCURATE
^ VISIBLE ADDRESS
^ CORRECT OCCUPANCY
^ VERIFICATION OF INVENTORY.MATERIALS
~ ^ VERIFICATION OF QUANTITIES
^ VERIFICATION OF LOCATION
^ PROPER SEGREGATION OF MATERIAL
^ VERIFICATION OF MSDS AVAILABILITY
^ VERIFICATION OF HAZ MAT TRAINING ~.~ `{\ - f3
J l~
"'^ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~ ~ ~O
^ EMERGENCY PROCEDURES ADEQUATE
^ CONTAINERS PROPERLY LABELED
^ HOUSEKEEPING
^ FIRE PROTECTION
^ SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITE? ^YES ~O ~~'~ ~'(~C-f3L,,n~c~ $•~ l~
EXPLAIN:
QUESTIO}NS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979
^~( ~~~.
Inspector (`Please Print) ~ Fire Prevention / 1~' In /Shift of Site/Station #
/^
t`
White -Prevention Services Yetlow -Station Copy Pink -Business Copy FD 2155 (Rev. 09105
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~~~41~ J'~~` CITY ®F BAKERSFIEL,D FIRE DEPARTMENT
~6~ ~ OFFICE OF ENVIRONIVIENTAL SERVICES
~~' •y UNIFIED PROGRAM INSPECTION CHECKLIST
~k•E'~gti~~ 1715 Chester Ave., 3~d Floor, Bakersfield, CA 93301
FACILITY NAME ~ 6 ^~ T e-~AL. ~ c ~ la 20 ~~ ~
Sectaon 4: Hazardous Waste Generator Program
INSPECTION DATE ~ ~ Z ~O
EPA ID #
^ Routine ® Combined ^ Joint Agency ^Muiti-Agency ^ Complaint ^ Re-inspection
OPERATION C V COMMENTS
Hazardous waste determination has been made
EPA ID Number
Authorized for waste treatment and/or storage
Reported release, fire, or explosion within 15 days of occurrence
Established or maintains a contingency plan and training
Hazardous waste accumulation time frames
Containers in good condition and not leaking
Containers are compatible with the hazardous waste
Containers are kept closed when not in use
Weekly inspection of storage area
Ignitablelreactivetyaste located at least 50 feet from property line
Secondary containment provided
Conducts daily inspection of tanks
Used oil. not contaminated with other hazardous waste
Proper management of lead acid batteries including labels
Proper management of used oil filters
Transports hazardous waste with completed manifest
Sends manifest copies to DTSC
Retains manifests for 3 years
Retains hazardous waste analysis for 3 years
Retains copies of used oil receipts for 3 years
Determines if waste is restricted from land disposal
=c;ompuance v=vtolat~on
Inspector:
Office of Environmental Services (661) 326-3979
White -Env. Svcs.
Business Site Responsible Party
Pink -Business Copy