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Home My WebLink AboutBUSINESS PLAN (3)~i _ • ' °°~ ,~ a U H i f i ~' - -~ ~_ ~Y .. _ 1~ r 4 s PHYSICIANS PLAZA SURGICAL CENTER Manager LINDA BLOOMQUIST Location: 6000 PHYSICIANS BLVD City BAKERSFIELD SiteID: 015-021-000858 BusPhone: ~-(661) 322-4744 Map 103 CommHaz :.High Grid: 19B FacUnits: -1 AOV: CommCode: KCFD STA 64 EPA Numb: SIC Code:8011 DunnBrad: Emergency Contact / Title Emergency Contact / Title LINDA BLOOMQUIST / ADMINISTRATOR BONNIE BUSH / BUS OFFICE MGR Business Phone: (.661) 322-4744x Business Phone: (661) 322-4744x 24-Hour Phone (661) 589-6256x 24-Hour Phone (661) 872-5652x Pager Phone (661) 333-0612x Pager Phone ( ) - x Hazmat Hazards: Fire Press React ImmHlth DelHlth Contact LINDA BLOOMQUIST Phone: (661) 322-4744x MailAddr: 6000 PHYSICIANS BLVD State: CA City BAKERSFIELD Zip 93301 Owner PHYSICIANS PLAZA SURG Phone: (661) 322-4744x Address 6000 PHYSICIANS BLVD State: CA City BAKERSFIELD ~ Zip 93301 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - PROG T - HAZ WASTE GEN ABOVEGROUND STORAGE TANK ~N~ ~ ~~ ~ ~ ~~~~ 3u ed on my it:quirk{ of these individuals tio , l the inform ` e r Q y onall reapcnsioie for o~.a;~~ng o~i la~~ that i hav., p lt y under pena an' i aml~~h~ nformationo is true, eyamined Mnd ~ ~~ submitted anc, b'~' late. accurate, anti comp - ------- Signature 1 Q ,~,_ -'- ~ zte -1- 07/13/2007 F PHYSICIANS PLAZA SURGICAL CENTER ~ Hazmat Inventory ~ MCP+DailyMax Order = SiteID: 015-021-000858 ~ By Facility Unit ~ Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE COMPRESSED F P IH G 563.00 FT3 Hi OXYGEN COMPRESSED F P IH G 256.00 FT3 Low DIESEL #2 F IH DH L 250.00 GAL Low NITROGEN COMPRESSED F P IH G 250.00 FT3 Min WASTE FIXER R L 5.00 GAL Min -2- 07/13/200,7 ,c F PHYSICIANS PLAZA SURGICAL CENTER ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME NITROUS OXIDE COMPRESSED Location within this Facility Unit TANK RM STATE TYPE PRESSURE _ Gas TPure Above Ambient SiteID: 015-021-000858 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 10024-97-2 TEMPERATURE CONTAINER TYPE Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Co563100rFT3 Daily 563100m FT3 I Daily 350r00e FT3 t1AGKKLVUJ 1:V1~lYV1Vi51V1J %Wt. RS CAS# 100.00 Nitrous Oxide No 10024972 nt~~~-~tcL .~aa~a~l~i~ivla TSecret RS BioHaz Radioactive/Amount EPA Hazards- NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME OXYGEN COMPRESSED Days On Site 365 Location within this Facility Unit Map: Grid: TANK RM CAS# 7782-44-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TPure ~-Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Co256100rFT3 Daily 256100m FT3 I Daily 200r00e FT3 r1H~rjtcLVUS ~vrirVlvrlvl~ %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 t1F~Gf-1K1J fj~JL" J~1~1~1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -4- 07/13/2007 F PHYSICIANS PLAZA SURGICAL CENTER SiteID: 015-021-000858 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME DIESEL #2 Days On Site 365 Location within this Facility Unit Map: Grid: AST CAS# 68476-34-6 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient ABOVE GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 250.00 GAL 250.00 GAL 125.00 GAL I1L'iL~l'iLCLVl.1J ~.V1•!t'V1V P~1V1J %Wt. RS CAS# 100.00 Diesel Fuel No. 2 No 68476302 11HGai1CL KJ JL' JJ1.11'.~1V la7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME NITROGEN COMPRESSED Days On Site 365 Location within this Facility Unit Map: Grid: OPERATING RM CAS# 7727-37-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 250.00 FT3 250.00 FT3 100.0.0 FT3 °sWt. 100.00 Nitrogen HAZARDOUS COMPONENTS RSI CAS# No 7727379 L1riL~1i1CL EiJ JJ; J.71~1L~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -5- 07/13/2007 F PHYSICIANS PLAZA SURGICAL CENTER SiteID: 015-021-000858 ~ ~ Inventory Item 0005 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site WASTE PHOTOGRAPHIC FIXER 365 Location within this Facility Unit Map: Grid: HALLWAY DARKROOM CAS# I Liquid TWaste ~ Ambient~E ~ AmbientT~E ~ PLASTIOCTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL iil-1c.~rucl.ivvJ t.V!•lYV1VP~1V 1 J %Wt. RS CAS# Silver No 7440224 t1tiL~riRL LiJ JI;J JI~1P.,1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -6- 07/13/2007 F PHYSICIANS PLAZA SURGICAL CENTER SiteID: 015-021-000858.E Fast Format. ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 04/14/2006 ~ SWITCHBOARD OPERATOR TO CALL FIRE DEPT 911. Employee Notif./Evacuation 04/14/2006 EMPLOYEE NOTIFICATION OCCURS WITH THE USE OF PULL ALARMS AND A CODE RED THAT IS USED OVER PA SYSTEM. EVACUATION OCCURS THROUGH FRONT, SIDE, AND REAR OF BLDG, AND EVACUEES GATHER AT W SIDE OF BLDG. Public Notif./Evacuation 04/1'4/2006 EVACUATION OCCURS THROUGH FRONT, SIDE, AND REAR EXITS OF BLDG. .PUBLIC GATHERS AT W SIDE OF BLDG. Emergency Medical Plan 04/14/2006 EMERGENCY MEDICAL EQUIPMENT AVAILABLE ON SITE. -7- 07/13/2007 F PHYSICIANS PLAZA SURGICAL CENTER SiteID: 015-021-000858 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 04/14/2006 ~ ALL GAS VALVES HAVE EMERGENCY BUZZERS AND MAIN SHUT-OFF VALVES. ALL STAFF MEMBERS KNOW HOW TO TURN OFF EMERGENCY VALVES AND HOW TO RESPOND TO ALARMS. ALL GAS LEVELS ARE MONITORED REGULARLY BY TRAINED PERSONNEL. Release Containment 04/15/1992 TANKS ARE CHAINED AND BRACED TO WALL. ROOM IS CONTAINED BY METAL DOOR. Clean Up 08/18/2000 GASES ARE EXHAUSTED THROUGH FAN ON CEILING OF TANK ROOM TO OUTDOORS. VLIIer Ke5(JUrCe HCl.1VC1l.1Utl -8- 07/13/2007 F PHYSICIANS PLAZA SURGICAL CENTER SiteID: 015-021-000858 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ w7~JC 1:10.1 nuc.al.u~ Utility Shut-Offs GAS - OR AREA & ACROSS FROM PREOP NURSES STA ELECTRICAL - NE SIDE OF BLDG WATER - N SIDE OF BLDG SPECIAL - OXYGEN, NITROUS OXIDE, CARBOGEN 05/09/2007 Fire Protec./Avail. Water 04/14/2006 PRIVATE FIRE PROTECTION - SPRINKLER SYSTEM, FIRE EXTINGUISHERS, AND EMERGENCY BOXES (FIRE ALARMS ARE ON SITE.) FIRE HYDRANT - NW CRNR PARKING LOT Building Occupancy Level 03/22/2006 52 EMPLOYEES -9- 07/13/2007 ~ 7; ~ -= f F PHYSICIANS PLAZA SURGICAL CENTER SiteID: 015-021-000858 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training .01/05/2007 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: ALL NEW EMPLOYEES ARE INSERVICED UPON. HIRE.- ALL EXISTING EMPLOYEES ARE INSERVICED YEARLY. rayc ~ . 1 J L . llC lli 1Vl 1'LLl.U1G V~G Held for Future Use -10- 07/13/2007 t--_ ~% _ ~~ I/ 3 PHYSICIANS/ PLAZA SURGICAL CENTER SiteID: 015-021-000858 Manager : 'j _I~Vl~fu_~_r0Oh~ ~15~~' BusPhone: (661) 322-4744 Location: 6000 PHYSICIAN BLVD Map 103 CommHaz High City BAKERSFIELD Grid: 19B FacUnits: 1 AOV: CommCode: KCFD STA 64 EPA Numb: SIC Code:8011 DunnBrad: Emergency Contact LINDA BLOOMQUIST Business Phone: 24-Hour Phone Pager Phone / Title / ADMINISTRATOR (661) 322-4744x (661) 589-6256x (661) 333-0612x Emergency Contact BONNIE BUSH Business Phone: 24-Hour Phone Pager Phone ~ Hazmat Hazards: Fire Press React ImmHlth DelHlth ~ Contact LINDA BLOOMQUIST Phone: (661) 322-4744x MailAddr: 6000 PHYSICIANS BLVD State: CA City BAKERSFIELD Zip 93301 Owner HEALTHSOUTH PHYSICIANS PLAZA SURG Phone: (661) 322-4744x Address 6000 PHYSICIANS BLVD State: CA City BAKERSFIELD Zip 93301 Period Preparers Certif' d: ParcelNo: Emergency Directives: to PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG T - ABOVEGROUND STORAGE TANK Oased on my inquiry of those individuals respcr!sib!2 for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, ~acc_urgate, and complete. V~ ~~~ ~~ Signature Date TotalASTs: _ TotalUSTs: _ RSs: No / Title_ / ' ~U.SI vi ei38 ~~LocJ . (661) 322-=4744x" (661) 872-5652x ( ) - x N'"A ~N~`~ I~AY 0 9 Z~89 Gal Gal -1- 02/06/2007 ,. , ~~- F PHYSICIANS PLAZA SURGICAL CENTER SiteID: 015-021-000858 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE COMPRESSED F P IH G 563.00 FT3 Hi OXYGEN COMPRESSED F P IH G 256.00 FT3 Low DIESEL #2 F IH DH L 250.00 GAL Low NITROGEN COMPRESSED F P IH G 250.00 FT3 Min WASTE FIXER R L 5.00 GAL Min -2- 02/06/2007 F PHYSICIANS PLAZA SURGICAL CENTER SiteID: 015-021-000858 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME NITROUS OXIDE COMPRESSED Days On Site 365 Location within this Facility Unit Map: Grid: TANK RM CAS# 10024-97-2 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas TPure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 563.00 FT3 563.00 FT3 350.00 FT3 HAZARDOUS COMPONENTS aWt. 100.00 Nitrous Oxide RSI CAS# No 10024972 i1LiGliiCL Hi J .71SJ.71~11",1V 1 iJ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME OXYGEN COMPRESSED Days On Site 365 Location within this Facility Unit Map: Grid: TANK RM CAS# 7782-44-7 ~GasATE TPureE ~AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 256.00 FT3 256.00 FT3 200.00 FT3 HAZARDOUS COMPONENTS owt. 100.00 Oxygen, Compressed RSI CAS# No 7782447 nrsatu~L .-~a ~r~a~~•l~lvla TSecret RS BioHaz Radioactive/Amount -EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -4- 02/06/2007 1 ~~ F PHYSICIANS PLAZA SURGICAL CENTER SiteID: 015-021-000858 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME DIESEL #2 Days On Site 365 Location within this Facility Unit Map: Grid: AST CAS# 68476-34-6 Liquid TMixture ~ AmbRent~E ~ AmbientT~E ABOVEOGROUNDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 250.00 GAL 250.00 GAL I 125.00 GAL - r1tiL.~ti.RLVUJ 1.V1~lYV1VL"1V1-5 oWt. RS CAS# 100.00 Diesel Fuel No. 2 No 68476302 ntiG1-1tCL 1-~.7A1",.7Jl~lt'~1V 1~~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No ~No/ Curies F IH DH / / / Low ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME NITROGEN COMPRESSED Days On Site 365 Location within this Facility Unit Map: Grid: OPERATING RM CAS# 7727-37-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas TPure ~-Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 250.00 FT3 250.00 FT3 I 100.00 FT3 ruyc~rucLVV.7 ~Vl~lt'V1VL~1V1J cwt. Rs cAS# 100.00 Nitrogen No 7727379 L1tiGtitCL Ii. 7.7~.7J1~1tS1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -5- 02/06/2007 ~: F PHYSICIANS PLAZA SURGICAL CENTER- SiteID: 015-021-000858 ~ ~ Inventory Item 0005 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site WASTE PHOTOGRAPHIC FIXER 365 Location within this Facility Unit Map: Grid: HALLWAY DARKROOM CAS# Liquid TWaste ~mbient~E ~ AmbientT~E -~STOICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 5.00 GAL HAZARDO US COMPONENTS %Wt. RS CAS# Silver No 7440224 rlti[~riRL Ci J Jl~J J1.1G1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -6- 02/06/2007 F PHYSICIANS PLAZA SURGICAL CENTER SiteID: 015-021-000858 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 04/14/2006 ~ SWITCHBOARD OPERATOR TO CALL FIRE DEPT 911. Employee Notif./Evacuation 04/14/2006 EMPLOYEE NOTIFICATION OCCURS WITH THE USE OF PULL ALARMS AND A CODE RED THAT IS USED OVER PA SYSTEM. EVACUATION OCCURS THROUGH FRONT, SIDE, AND REAR OF BLDG, AND EVACUEES GATHER AT W SIDE OF BLDG. Public Notif./Evacuation 04/14/2006 EVACUATION OCCURS THROUGH FRONT, SIDE, AND REAR EXITS OF BLDG. PUBLIC GATHERS AT W SIDE OF BLDG. Emergency Medical Plan 04/14/2006 EMERGENCY MEDICAL EQUIPMENT AVAILABLE ON SITE. -7- 02/06/2007 F PHYSICIANS PLAZA SURGICAL CENTER SiteID: 015-021-000858 ~ ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention 04/14/2006 ~ ALL GAS VALVES HAVE EMERGENCY BUZZERS AND MAIN SHUT-OFF VALVES. ALL STAFF MEMBERS KNOW HOW TO TURN OFF EMERGENCY VALVES AND HOW TO RESPOND TO ALARMS. ALL GAS LEVELS ARE MONITORED REGULARLY BY TRAINED PERSONNEL. Release Containment 04/15/1992 TANKS ARE CHAINED AND BRACED TO WALL. ROOM IS CONTAINED BY METAL DOOR. Clean Up 08/18/2000 GASES ARE EXHAUSTED THROUGH FAN ON CEILING OF TANK ROOM TO OUTDOORS. v~iici rce5c~urce HCL1vaLlon -8- 02/06/2007 P PHYSICIANS PLAZA SURGICAL CENTER SiteID: 015-021-000858 ~ Fast Format ~ ~ Site Emergency Factors Overall Site a .7~lCUld1 ndzaras Utility Shut-Offs 04/14/2006 A) GAS - OR AREA & ACROSS FROM PREOP NURSES STA B) ELECTRICAL - NE SIDE OF BLDG C) WATER - N SIDE OF BLDG D) SPECIAL - OXYGEN, NITROUS OXIDE, CARBOGEN E) LOCK BOX - NO Fire Protec./Avail. Water 04/14/2006 PRIVATE FIRE PROTECTION - SPRINKLER SYSTEM, FIRE EXTINGUISHERS, AND EMERGENCY BOXES (FIRE ALARMS ARE ON SITE.) FIRE HYDRANT - NW CRNR PARKING LOT Building Occupancy Level 03/22/2006 52 EMPLOYEES -9- 02/06/2007 ~; - ~. F PHYSICIANS PLAZA SURGICAL CENTER SiteID: 015-021-000858 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 01/05/2007 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: ALL NEW EMPLOYEES ARE INSERVICED UPON HIRE. ALL EXISTING EMPLOYEES ARE INSERVICED YEARLY. rays ~ Held for Future Use nciu ivl. r u~.utc vac -10- 02/06/2007 _~ ,- ~, + PHYSICIANS PLAZA SURGICAL CENTER ____________________ SiteID: 015-021-000858 + Manager Location: 6000 PHYSICIANS BLVD City BAKERSFIELD BusPhone: (661) 322-4744 Map 103 CommHaz High Grid: 19B FacUnits: 1 AOV: CommCode: KCFD STA 64 EPA Numb: SIC Code:8011 DunnBrad: Emergency Contact / Title Emergency Contact / Title LINDA BLOOMQUIST / ADMINISTRATOR BONNIE BUSH / Business Phone: (661) 322-4744x Business Phone: (661) 322-4744x 24-Hour Phone (661) 589-6256x 24-Hour Phone (661) 872-5652x Pager Phone ((.~(~ ~ ) g33 - f~torL x Pager Phone ( ) - x Hazmat Hazards: Fire Press. React ImmHlth DelHlth Contact Phone: (661) 322-4744x MailAddr: 6000 PHYSICIANS BLVD State: CA City BAKERSFIELD Zip 93301 Owner HEALTHSOUTH PHYSICIANS PLAZA SURG Phone: (661) 322-4744x Address 6000 PHYSICIANS BLVD State: CA City BAKERSFIELD Zip 93301 Period to - TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG T - ABOVEGROUND STORAGE TANK ENro App ~ 4 2046 Based on my inquiry ^f those individuals responsible for obtaining the information, I certify under penalty of law that I have personally e.camined and am familiar with the information submitted and heligye the information is true, accurate, and complete. ~`~` ~1 Z~1oL Signa-' tu"- re -~-------_ Date -1- 03/22/2006 HAKERSFIELD FIRE DEPT P t D Prevention Services r/t1 900 Truxtun Ave., Suite 210 ~wfM r Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAM ~ ~ r ~~ L ~ ~ INSPECTION DATE INSPECTION TI I - t ~-7f . 00 ~l ~~ ADDRESS ~j G % ~ !3 ~!/ HONE NO. O OF EMPLOYEES 2Z~ / - r f :~-~0 FACILITY CONTACT USINESS ID UMBER 15-021- Section 1: Business Plan and Inventory Program -- t7~- OUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=violation COMMENTS APPROPRIATE PERMIT ON HAND ~~ ^ BUSin@SS 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 ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ~.. ^ HOUSEKEEPING ^ FIRE PROTECTION ~- ^ SITE DIAGRAM ADEQUATE & ON HAND I~ JJ ANY HAZARDOUS WASTE ON SITE? ^ YES ~p EXPLAIN: -(tt/~~~ ~/,~~t/J. ~` DING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) / 1°' In /Shift of Site/Station # 2i?o5 I i usiness Site/School to Responsible Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD2049 (Rev.lY2/OS)