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Home My WebLink AboutBUSINESS PLAN 7/18/2007i~ ,E6ST HILL FAMILY DENTISTRY ~~2600 OSWELL #F SEP y 1Q03 T EAST HILLS FAMILY DENTISTRY SiteID: 015-021-002407 Manager : JESSZE CORRAL Location: 2600 OSWELL ST City BAKERSFIELD BusPhone: (661) 871-4132 Map 103 CommHaz Minimal Grid: 23A FacUnits: 1 AOV: CommCode: BFD STA 08 EPA Numb: CAL0002970$1 SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title 6~E~FB3i:-NE~MS=~Gt;~:~%.Z. ~~~~'RONT DESK SUPR JESSIE CORRAL DDS f MANAGER Business Phone: (661) 871-4132x Business Phone: (661) 871-4132x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact : ~~T~•N~~t'~EI7MS ~nn~ ~ ~•~~ ~ Z Phone : ( 6 61) 8 71- 413 2 x MailAddr: 2600 OSWELL ST State: CA City BAKERSFIELD Zip 93306 Owner CORRAL DENTAL CORP Phone: (661) 871-4132x Address 2600 OSWELL ST State: CA City BAKERSFIELD Zip 93306 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN EN Ta ~ /' `='~ced nn my inquiry of Those individuals reS~:r_.n~,;;;le for obtaining thQ informatio I n, certify uncier• penalty or' law that I have examined and am famil submitted and belie personally iar with the information ve accurate, and complete. the information is true, '~ ~~ ~ ~ '~7/ s ~ Siynature~'-"' ~m~~Q~y ~~~~; Date T~~~e a~~~ ~~7~ : ~o tea,` y~.~ ~. ~ -1- 07f11f2007 F EAST HILLS FAMILY DENTISTRY SiteID: 015-021-002407 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE FIXER ~ R L 20.00 GAL Min -2- 07/11/2007 -3- 0~/11/aoo~ F EAST HILLS FAMILY DENTISTRY SitelD: 015-021-002407 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: DARKROOM UNDER SINK C'AS# Liquid TWaste -~mbient~E ~ AmbientT~E ~ PLASTICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 20.00 GAL 20.00 GAL 20.00 GAL t1AGAttLVUS l:vl~lrvlvi5ly 15 oWt. RS CAS# Silver No 7440224 t1AGHKL HSal"~551~1t51V 1"5 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 07/11/2007 r "' F EAST HILLS FAMILY DENTISTRY SiteID: 015-021-002407 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification Employee Notif./Evacuation ,~ tU3.J1 J. 1. 1VV 1.11. ~ P~VQVUdl.1 V11 P~lllC l.y Clll: ~/ 1.1C U1C.:d1 t'1d11 -5- 07/11/2007 r -. F EAST HILLS FAMILY DENTISTRY SiteID: 015-021-002407 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention Release Containment ~.icaii vN V1.11C1 1CC~VUiI:C 1'il~l.lVdl.lVll -6- 07/11/2007 :.- FEAST HILLS FAMILY DENTISTRY SiteID: 015-021-002407 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ J~1C 1:1d1 I1dGdl Ua Utility Shut-Offs Fire Protec./Avail. Water ,_ ~..a u.iius.iiy v~.. ~.u~att~.y Lcvc.L -7- 07/11/2007 ~ ._ n`, - '`~' F'~EAST HILLS FAMILY DENTISTRY SiteID: 015-021-002407 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training rayc ~ Held for Future Use _, ~ t_ aiciu ivi ru~.utc ~~c -8- 07/11/2007 ' .. ~ i _- _ . ., .. _ - ~ - . r. 6 G-: ~ :?;'::i'ti"P ._pA~;'~ 1s:---'~-.r,~~ 4r~, ~ , ;y _ _•ti'v,' : ;i-•~_ ~-~ _ - ~ - . - ~_}.< _ _ r -.Q..t ;3;c ._.,,~,..-r-', ~~• BAKERSFIELD FIRE -DEPT. ~~~ Prevention Services FIRE PREVENTION INSPECTION B EF/Re t L ~ 900 Truxtun Ave., Ste. 210 - ARTM T Bakersfield, CA 93301 I" ~ Tel.: (661) 326-3979 0 Fax: (661) 2-2171 DISTRICT BLOCK NO. DA~ ~. ~j ~~~ EE" ~, pq~ FACILITY ADDRESS ~ CITY, STATE, ZIP FACILITY NAME ^~"~~~ ~ f `, ~ t,. ~ ~ ~ ~ MANAGER'S NAME FACILITY PHONE NO. BUSINESS OWNER'S NAME AND%ADDRESS ~ CITY, STATE, ZIP OWNER'S PHONE NO. BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, ZIP, BILLING PHONE NO. OCC TYPE OCC LOAD NO. OF FLOORS HIGH RISE BLDG RISER DATE ^ YES ^ NO CORRECT ALL VIOLATIONS vio~~rio. ~ REQUIREMENTS CHECKED BELOW No. COMBUSTIBLE WASTE I DRY 1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.) VEGETATION 2 Provide non-combustible containers with tight fitting lids for the storage of combustible waste and rubbish pending its safe disposal (U.F.C.) COMBUSTIBLE STORAGE 3 Relocate combustible storage to provide at least 3 feet clearance around motor fuse box/fire door (N.E.C.) (U.F.C.) 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) EXTINGUISHERS 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.) 7 Provide and maintain "EXIT" sign(s) with letters 5 or more inches in height over each required exit (door/window) to SIGNS fire escape. (U. F.C.) ' g Provide and maintain appropriate numbers on a contrastin b~aund and visible from the street to indicate the correct address of the building. (B. M.C.) (U.F.C.) g Repair all (cracks/holes/openings) in I in on) ______________________________________. Plastering FIRE DOORS/ FIRE SEPARATIONS shall return the surface to its origina r is ive condition. (U.B.C.) , 10 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.C.) EXITS 11 Remove all obstruction from hallways. Maintain all means of egress free of any storage. (U.F.C.) 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.C.) ------------------------------ STORAGE 13 Remove all storage and/or other obstructions from fire escape landings acid stairways stair shafts. (Fire escapes/stair shafts are to be maintained free from obstructions at all times.) (U.F.C.) 14 Extension cords shall not be used in lieu of permanent approved wiring. Install additional approved electrical outlets ELECTRICAL APPLIANCES where needed. (N.E.C.) (U.F.C.) 15 Remove multiple attachment cords from specific electrical convenience outlet (one plug per outlet) (N. E.C.) (U.F.C:) OUTDOOR BURNING 16 Violation of Section 1102 dealin with recreational fires or o en burnin U.F.C. FIREWORKS 17 Violations of Section 7802 U.F.C. or 8.49.040 of the Bakersfield Munici al Code B.M.C. re ar d in fireworks. OTHER 18 / r ~ ~~fi'1''~/;( S r : ,+~.+t~AP ~ wv .71 L" . L-+; 'rY_ ~.,~r .f J m~~' ~~ .~oS f1~! ~ S/`~i Y , t .~~i/f'..t.i //~ _ - - r - - - ~ -- _~.~ ._ . U'>Z ,lr~ .f I Ott r V ( ( CUSTOMER: ~ ~~ udt~,(c C_t~i( ~ GS .'Yf ~ R , ~ E ND. . ~~ (Signature) ~ (Please Print Name Legibly, Title) ~ C F.C CALIFORNIA FIRE CODE U.B.C. UNIFORM BUILDING CODE ,/ r _-" - G ' ` -" B.M.C. BAKERSFIELD MUNICIPAL CODE INSPECTOR: / t~a.,~a AP NO.: l % " N.F.P.A. NATIONAL FIRE PROTECTION f (S19natUre) ASSOCIATION N.E.C. NATIONAL ELECTRIC CODE rcer-i~zu White -Customer/original Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09/05) 11127!2006 16:36 8585588291 FIRE AND SAFETY PAGE 07 ee/~^2~2806 Y6: 36 8985588291 FIRE aND ~IFETV Pi4GE 0r ~,~l11r~,E HC~QD S~~DRT +iY.+~T14J1rAL ~1~D1EC77~AN~V11~.1~V~ (~BA~ ~iT.~4AT ,~:~,~ - 3 ?-~ C ~vo~- c~~ c~+eS'bL ~,: - ~i 3 3~a ~ ~i0d1-_ - - - -- ~~,,,~~~1 ~o:.+r•.~. f ~r ~ ~e~ir dtrCA eons 1, ~~a Cam-- Gsr. xsro~tr~sxslar~rirmr.ua7oRrx~r pld;~;al.t.aasblaw Igatl~ rem: • IoN~s sa~cus7~ sne~e-~Inn-~ro r3wv~ ~rrios .. jas~rsrar[ s~vncr~. 49 ~ti f~ d M 1i Qd j, fyeall edtlYd ti0ed p~IMf3a1101OR~ M~ ~ ~1e R~ AmR~I~ ~ f~1Y111d 76~~ 11 ERe ~~! ~(~,p,A,~1~~~~AtOdllll. Z~~11~`~~7 ~9 ~1 ~ dit/RQI~fQIL' '~ ~ '. 8a1~fJ~~9~d~IR .~ Za s ~1hi~>Q~Mw l~BeagpfeORbtasv~ewlha~1g4~1~r~n ~ if~lt p~n~ ~. i41oa111 s ie d1+4 . ~~' d7a0~f. ~ T'~~ w - bl ~II+>ve6ifdlpa/pMnAOeAeha 1K~ drt e~enll ~~.I~Hypeade s~ ~lilii~,~.„ S. ~m1ed1E~r1~i.~lalAw•dr1Q ~ ~ i~ 66fa ~ flt+ i ~ ~ B~mae e(u~ sl~u ~aryae a ~teds 4te emtrd n roq ~~~11~'~M1~b01~1i0d1f1pbtRAarsfylYl. ^1~ .. C a w1l ~ 7. ~ q~ }ryas rlu~~ ~pllba ~ wa91d4 ~!~ ~ 1. ~IAI dl! ~ wtnk111~T 9.7,1 ~q} ~lIQII a t1L 7047 YBS '~1~0~~11~l~Oti1~{d~uL.~IGl1C4IOtl~lidl~. ~l~lemd~lAi~t~~ f1li~Pl~l011d~~ YDw7Y~i~10~l~AehtIRt4TlIOpI'OpL'-Ffllpnaedaa. IIIkMUk~w"i~i~l~-- ~e~. M/b wp pu(~L 7• aa[~C yei~ d)k l dx Ifels se11e1e6 911 +G, 1. ~9bl~eie+laeledadai~ mtiAm did 8~e fyaaem+wspel7+~rB! ioa~pact~~i ild lblupl ~{Iqp! m Bi ad Ot~lOd i6 ~ fR{~OIL UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1: Business Plan and Inventory Program Section 1: Business Plan and Inventory Program `~ ~ D! ~' ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION • Prevention Services A F R s e _, . „ 9001Yuxtun Ave., Suite 210 FARE Bakersfield, CA 93301 ARTM t Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME ` ` I ~- ` INSPE ION DATE 3~ -1 INSPECTION TIME i ~r: zg 5 t , ~ ~ . ADDRESS ,\ 11 ~(c V ~l ~ ` ~ ` ~ ~ c PH~OXN"ENO. u U~'^_l'~~ NO OF EMPLOYEES FACILITY CONTACT - - - ~e SS i e Co~'Ir ~t~,s BUSINESS ID NUMBER 15-021- (~ ~j Zy ~ } C V ~ C=Compliance. OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY O ^ VERIFICATION OF INVENTORY MATERIALS ~~ ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ ^ VERIFICATION OF MSDS AVAILABILITY ~~ ^ VERIFICATION OF HAZ MAT TRAINING ~ !~' K ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ 'EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? YES ^ N~ t~/~~ ~-~~ EXPLAIN. QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~~~1 a~ Inspector (Please Print) Fire Prevention / 1s` In /Shift of Site/Station # s e e es nsi (Ple rint) White -Prevention Services .Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 ,. , y< -. :,>,..,V- 2.. - ,.. ,. 't.' ._, -.. , %.... _.v -s .~,. f .. ...- ... _.. - .. .- t,uw::a .~y~,, r~.O;w~Vi« .2,--'~s.r_..,,_ 7 .. . .,, ...- 1i FIRE PREVENTION INSPECTION B B R S P I D i/BE ARTN T BAKERSFIELD FIRE DEPT. Q~~ Prevention Services ~3 UU 900 Truxtun Ave., Ste. 210 ~~ Bakersfield, CA 93301 Tel.: (661) 326-3979 ^ Fax: (661) 852-2171 DISTRICT BLOCK NO. DATE '7~/ ~ O EE ,OO FACILITY ADDRESS ~~ ~J l~[J ~ CITY, STATE, ZIP FACILITY NAME ~ , MANA ER'S NAME ~ ,~( FACT NE ~. r/~ ~ t l s ~ BUSINESS OWNER'S NAME A D ADDRESS CITY, STATE, ZIP OWN 'S ONE N BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, 21 P, BILLING PHONE NO. OCC TYPE OCC LOAD NO. OF FLOORS HIGH RISE BLDG RISER DATE ^ YES ^ NO CORRECT ALL VIOLATIONS VIOLATION REQUIREMENTS CHECKED BELOW No. RY O 1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.) C MBUSTIBLE WASTE /D VEGETATION 2 Provide non-combustible containers with tight fitting lids for the storage of combustible waste and rubbish pending its safe disposal. (U.F.C.) COMBUSTIBLE STORAGE 3 Relocate combustible storage to provide at least 3 feet clearance around motor fuse box/fire door (N.E.C.) (U.F.C.) " 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) EXTINGUISHERS 5 Provide and install (amount) _~ approved (type 8 size) _ _,YG~~~ __ portable fire extinguisher to be - ---- immediately accessible for use in (area) ~ _________________ (U.F.C.) g Re-charge all fire extinguishers. Fire extinguishers shall be serviced at least once each year, and/or after each use, by a person having a valid license or certificate. (U.F.C.) 7 Provide and maintain "EXIT° sign(s) with letters 5 or more inches in height over each requl d 't o ow) to SIGNS fire escape. (U.F.C.) g Provide and maintain appropriate numbers on a contrasting background and visible from the street to indicate the correct address of the building. (B.M.C.) (U.F.C.) g Repair all (cracks/holes/openings) in plaster in (location) __________________________________. Plastering FIRE DOORS/ FIRE SEPARATIONS shall return the surface to its original fire resistive condition. (U.B.C.) 10 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.C.) EXITS 11 Remove all obstruction from hallways. Maintain all means of egress free of any storage. (U.F.C.) 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.C.) STORAGE 13 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 all times.) (U.F.C.) 14 Extension cords shall not be used in lieu of permanent approved wiring. Install additional approved electrical outlets ELECTRICAL APPLIANCES where needed. (N.E.C.) (U.F.C.) 15 Remove multiple attachment cords from specific electrical convenience outlet (one plug per outlet) (N.E.C.) (U.F.C.) OUTDOOR BURNING 16 Violation of Section 1102 dealin with recreational fires or o en burnin U.F.C. FIREWORKS 17 Violations of Section 7802 U.F.C. or 8.49.040 of the Bakersfield Munici al Code B.M.C. re ardin fireworks. OTHER 18 ,f F~ 5 ~ v:~ ~'~• ~U. ~ ~1~ ~e ~~s ~d,e_ ar~~; ~ ; ,v .. ~' ,~.. ~ <<,a,~ G,/Z, L? J' ~~ K - ..~il//..s'd5 ~- r .~ CUSTOMER: ._ ~--'' i•~'1G r : n ~, M N1Gvt ~ LEG ND: ., ~ C.F.C. CALIFORNIA FIRE CODE (Signature) (Please Print Name Legibly, Title) U.B.C. UNIFORM BUILDING CODE l B.M.C. BAKERSFIELD MUNICIPAL CODE ^ INSPECTOR: ~"1~~ AP NO.: ~ N.F.P.A. NATIONAL FIRE PROTECTION _ ~gr~latUre) ASSOCIATION N.E.C. NATIONAL ELECTRIC CODE White - CustomarlOriginal Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09105) EAST HILLS FAMILY DENTISTRY Manager fPSS i e C~/'/Y,a:.L Location: 2600 OSWELL ST City BAKERSFIELD CommCode: BFD STA 08 EPA Numb: CAL000297081 SiteID: 015-021-002407 BusPhone: (661) 871-4132 Map 103 CommHaz Minimal Grid: 23A FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title WENDY NELMS / Sc,yoei-viSOr (~rom~Qs JESSIE CORRAL DDS / l~~9'~ Business Phone: (661) 871-4132x Business Phone: (661) 871-4132x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact WENDY NELMS Phone: (661) 871-4132x MailAddr: 2600 OSWELL ST State: CA City BAKERSFIELD Zip 93306 Owner CORRAL DENTAL CORP Phone: (661) 871-4132x Address 2600 OSWELL ST State: CA City BAKERSFIELD Zip 93306 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ENT'D F E B 2 3 2007 Based on my inquiry of those individuals responsible for obtaining the information, 1 certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. ~ ~-~~~ ] Signature Date -1- 01/30/2007 F EAST HILLS FAMILY DENTISTRY ~ Hazmat Inventory ~ MCP+DailyMax Order = SiteID: 015-021-002407 ~ By Facility Unit ~ Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE FIXER R L 20.00 GAL Min -2- 01/30/2007 -3- 01/30/2007 F EAST HILLS FAMILY DENTISTRY ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME WASTE FIXER Location within this Facility Unit DARKROOM UNDER SINK SiteID: 015-021-002407 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# STATE TYPE PRESSURE Liquid TWaste ~ Ambient TEMPERATURE ~ CONTAINER TYPE Ambient - I PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 20.00 GAL 20.00 GAL 20.00 GAL ru~~tucLVUS ~vi~irulv~lv~l~5 %Wt. RS CAS# Silver No 7440224 t1AGAK.L HJ5~751~11";1V~1~5 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 01/30/2007 F EAST HILLS FAMILY DENTISTRY SiteID: 015-021-002407 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ AgencZr Notification ,~ Ldll~JlVxCC 1VV l.1L ~ P~VQI~UQl.1 V11 Public Notif./Evacuation l~ulc.~~cll~,y ricui~.Q.l. riQ11 -5- 01/30/2007 F EAST HILLS FAMILY DENTISTRY SiteID: 015-021-002407 ~ Fast Format ~ ~ Mitigation/PreventJAbatemt Overall Site ~ ~ Release Prevention 1CC1Cdb"C 1.V111.d111lllCill. ~..~.cait vt/ Other Resource Activation -6- 01/30/2007 F EAST HILLS FAMILY DENTISTRY SiteID: 015-021-002407 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~ Special Hazards Utility Shut-Offs . ,. , i~ i.~c riv~..c~.. / rava.ii . rva~ct aU1111111y V1.: 1. 1.L11Cllll.:Y LC V C1 -7- O1j30j2007 -~ .. F EAST HILLS FAMILY DENTISTRY SiteID: 015-021-002407 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training ruyc ~ nciu ivi rut,uic vac nc.i.u ivi ru~.u1.C u5C -8- 01/30/2007 UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business .Plan and Inventory Program Bakersfield Fire Dept. ' Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel: (661) 326-3979 FACILITY NAME WSPECTION GATE INSPECTION TIME t I ~ 'ADDRESS PHONE No. No. of Empbyees FACILITYCONTACT Business ID Number 15-021- d cj-Z 7 Section 1: Business Plan and Inventory Program ®'Routine O Combined O Joint Agency ^Mu1ti-Agency ^ Complaint ^ Re-inspection C V ~ V=Vio atiolnn~) OPERATION COMMENTS L~ _ ^ _ APPROPRIATE PERMIT ON HAND- _______ _-________- _.._._ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE T ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ ~ VERIFICATION OF INVENTORY MATERIALS .__. _ . _. _. . _. ... __ _- ---. _ . - ^ . I VERIFICATION OF QUANTITIES . _........_ . _ .. _ - - O ^ .VERIFICATION OF LOCATION ® ^ PROPER SEGREGATION OF MATERIAL "s' ^ VERIFICATION OF MSDS AVAILABILITYE ^ VERIFICATION OF HAT MAT TRAINING ' ^ VERIFICATION OF ABATEMENT SUPPLIES ANO PROCEDURES ^ ^ EMERGENCY PROCEDURES ADEQUATE - ^ ----- ^ ---..___._._..-----------------------__. --- --------------....._._.. CONTAINERS PROPERLY LABELED I -- -- .... ......... ... ---.......... -- . _._. _..._..._...._ _..... _..._..----. .. ._____....... }} ^ QI HousEKEEPING [,, n _.. ___ .. _ _.__ _ ~~ - 1 ~+ "'7 ~ C ~, P ._ I ~ ~G?I"~"~. ~ ^. FIRE PROTECTION ~ ^ SITE DIAGRAM ADEQUATE Sr ON HANG ANY HAZARDOUS WASTE ON SITE?: ^ YES i~ NO EXPLAIN: ~ .. , . - _. ,_ _ ._. .. __ ...._~.._ .._.. _.M.._.__. _ ._. _ ___-~_.... .._._. . QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT ~ss~ ~ 32i)-3979 n Inspector (Please 'nt) Fire Prevention 1s1-InlShik of.Site Business Site Responsible~Party (Please Pnnt) ~ J -~ ~ Whke -Environmental Servi~a Vellow -Station Copy Pink -Business Copy UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program l --- -: Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME ~ INSPECTION DATE INSPECTION TIME -----~ ~~ i- - - ~~ L LS ----1~1'`_~ L_`Y----- ~_ l N T1 S --- -- ---- -- -~'_' O(e ~~ Z __ ._ ~ n9lLJ - ---.. ADDRESS P NE No. No. of Employees FACILITYCONTACT Business ID Number ~ 15-021- GdC.'F0~ Section 1: Business Plan and Inventory Pn~gram O Routine ^ Combined ^ Joint Agency ^Mutti-Agency ^ Complaint ^ Re-inspection C V \V=Vioapolnncel OPERATION ~ J COMMENTS lJQ ^ --~ APPROPRIATE PERMIT ON HAND ^ BUSINESS 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 AVAILABILITYE ^ VERIFICATION OF HAT MAT TRAINING ^ / ` VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~ ^ EMERGENCY PROCEDURES ADEQUATE ~~.q'~j( ^ ----- CONTAINERS PROPERLY LABELED ------- -- ^ ---------------- HOUSEKEEPING - -------------- ^ FIRE PROTECTION ----- ----------- ------------------- ^ SITE DIAGRAM ADEQUATE 8c ON HAND ANY HAZARDOUS WASTE ON SITE: ^ YES ~NO `"~ ~'; i'"~ ~ { ~, i r ....~ EXPLAIN: ..~.:~ ~ ~°'f QUESTIONS REG RDING THIS INSPECTIONS PLEASE CALL US AT ~F>6'I ~ 3X)-3979 I spe for Badge No. White • Environmental Services Yellow -Station Copy Business Ite Responsible Party /~ Pink -Business Copy ~ ~ _y ~ + EAST HILLS FAMILY DENTISTRY _________________________ SiteID: 015-021-002407 + Manager Location: 2600 OSWELL ST City BAKERSFIELD BusPhone: (661) 871-4132 Map 103 CommHaz Minimal Grid: 23A FacUnits: 1 AOV: CommCode: BFD STA 08 SIC Code: EPA Numb : LA L ppQ ~9' 70~/ DunnBrad Fmer_ctency Contact / Title Emergency Contact / Title _ Jc ss ~ ~ c a;e,Q,q L / / Business Ynone: (661) 871-4132x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact ~ C(fCr1dY /~C:Lr~ s Phone: (661) 871-4132x MailAddr: 2600 OSWELL ST State: CA City BAKERSFIELD Zip 93306 Owner i1(%SS%~ Gcu~R~4L DDS / C4~~c DEnTstG CpR~ Phone: (661) 871-4132x Address 2600 OSWELL ST State: CA City BAKERSFIELD Zip 93306 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: ~ Emergency Directives: ~ PROG A - HAZMAT PROG H - HAZ WASTE GEN Based on my inquiry of thane Individuals responsible far obtaining thA Information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the Infprmation is true, accurate, and complete. Signature. Date E~ A ~~ ~ ~ ~B®~ -1- 03/10/2006