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HomeMy WebLinkAboutBUSINESS PLAN 5/11/2006~~ ~P I~ TERRANCE M LUKENS DDS'INC (' ,~ _ A ,._ ~T. ,~, y-~f~ *~~~,.. c ~ , • ~~,.~~^ `JJ ~J o Y~ ,(.~: 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 DATE INSPECTION TIME ADDRESS ~ PHONE No. No. of Em loyees ~~~ ~~~n _~ - -..~ - ---....-_ -___..-.----- ._ .-.__.__._, _- -- 3 _Z~r~3-- -- -------------------------._-~- ~.~-- - ~- ---6~------- - - FACILITYCONTACT ~~ 8usmess ID Number ® ~~~ 15-021- Section 1: Business Plan and Inventory Program Routine O Combined ~ Joint Agency ~ Multi-Agency ~ Complaint O Re-inspection • ANY HAZARDOUS WASTE ON SITE?: ^ YES ~'NO EXPLAIN: • QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661 ~ 32iJ-3979 r-~ Inspector (Please Print) Fire Prevention 1st-InlShift of Site White -Environmental Services Yelbw -Station Copy .~_ _ usiness Site Responsibl Ay (Please Print rn Pink -Business Copy a ~ ~, LUKENS DDS.TERRANCE M Manager ~ T~'~6~-ham M ~-Vv(.~1 i7'DS Location: 3807 SAN DIMAS ST 13 City BAKERSFIELD SiteID: 015-021-000840 BusPhone: (661) 327-0835 Map 103 ~CommHaz High Grid: 19B _FacUnits: 1 AOV:. CommCode: BFD STA 04 EPA Numb: CAL000099067 SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title TERRANCE LUKENS DDS / OWNER ROBERT LUKENS MD / OWNERS FATHER Business Phone: (661) 327-0835x 24-Hour Phone (661) 872-1014x 24-Hour Phone (661) 325-2382x. Pager Phone (661) 343-0655x Pager Phone ( ) - x Hazmat Hazards: ~. Fire Press React ImmHlth Contact TERRANCE M LUKENS DDS _ Phone: (661) 327-0835x MailAddr: 3807 SAN DIMAS ST 13 State: CA City BAKERSFIELD Zip 93301 Owner TERRANCE M LUKENS DDS Phone: (661) 327-0835x Address 12101 CATTLE KING DR State: CA City BAKERSFIELD Zip 93306 Period to TotalASTs: _ Gal Preparers- ~ TotalUSTs: = Gal Certif'd: ~, .RSs: No ParcelNo: Emergency Directives: PROG A- HAZMAT , ~- ~ u,;l~ ENT'D F E B 6 2 2007 based on my inquiry of those indivic;ua?s 1 certify ansibie tar obtaining the information res ~~ W.. , p under penalty of !aw that I have personally ~ ~~~ ~ ~ -.02_ 0. examined and am ar iar with- the information ~ submitted a d h., _v the information is true, ~~`.~'"~' ~ . accurat I e. ~~ -~ Date Sign ,are -1- 02/02/2007 c. 'I F LUKENS DDS TERRANCE M ~ Hazmat Inventory ~ MCP+DailyMax Order = SiteID: 015-021-000840 ~ By Facility Unit ~ Fixed Containers an Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE F P IH G 13550.00 FT3 Hi OXYGEN F P IH G 281.00 FT3 Low WASTE FIXER R L 2.00 GAL Min -2- 02/02/2007 -3- 02/02/2007 n', e F LUKENS DDS TERRANCE M SiteID: 015-021-000840 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME ~ITROUS OXIDE Days On Site 365 Location within this Facility Unit Map: S OF BACK DOOR INSIDE BLDG AND E END OF BLDG HALL WALL NEXT TO RECEPTION DOOR ~GdSATE TYPE PRESSURE TEMPERATURE TPure Above Ambient Ambient Grid: CAS# CONTAINER TYPE _ PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATIONI Largest Co300100rFT3 Dai113550100m FT3 I Daily 300r00e_FT3_ - rlti~tatcLUUa ~ul~irulvr~iv 15 oWt. RS CAS# 100.00 Nitrous Oxide No 10024972 tifjGl~K1.1 AS~1;571~1~1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ ~ COMMON NAME / CHEMICAL NAME I OXYGEN Days On Site Location within this Facility Unit Map: S OF BACK DOOR INSIDE BLDG AND E END OF BLDG HALL WALL NEXT TO RECEPTION DOOR 365 Grid: CAS# 7782-44-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas TPure ~-Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 281.00 FT3 281.00 FT3_ 281.00 FT3 r1~Lxtcl.~uu~ uvrirvivl;.lvr~ %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 tiL-~GAKLJ AS~L"~551~1L"~1V'1'S TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -4- 02/02/2007 F LUKENS DDS TERRANCE M ~ Inventory Item 0003 COMMON NAME / CHEMICAL NAME WASTE FIXER c nT~t.~. *+rrnm~r+D T D'L7T ~T_~R --~'~lY 1 i L3V 1 V VSQ$sTaSV ZTZ1L Location within this Facility Unit DARKROOM ,~~ ,~, STATE TYPE PRESSURE Liquid TWaste -Ambient SiteID: 015-021-000840 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Grid: CAS# ~E~2.A'IURE CONTAINER TYPE Tent ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 2.00 GAL 2.00 GAL -2.00 GAL riAGHKLVU~ 1.:U1~lYV1V151V1J ~Wt. RS CAS# Silver No 7440224 riAGH.ttL Aa 71"~551~11";1V 1 7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies. R / / / Min b _~ y ~ ~q ~ ~~ -5- 02/02/2007 ._ -, F LUKENS DDS TERRANCE M SiteID: 015-021-000840 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 01/18/2000 ~ CALL 911. Employee Notif./Evacuation 03/27/2006 CALL 911, NORMAL EVACUATION AND SHUT-DOWN OF SYSTEM. Public Notif./Evacuation 03/27/2006 IN CASE OF FIRE, BLDG EVACUATED, GASES SHUT OFF (USUALLY OFF), ALL EMPLOYEES TRAINED IN EVAUUATION AND IN PROPER EMERGENCY PROCEDURES,IE, FIRE EXTINGUISHER, GAS VALVES SHUT-DOWN, CPR, ETC. Emergency Medical Plan NEAREST HOSPITAL - MEMORIAL - 420 34TH ST - 327-1792. 01/18/2000 -6- 02/02/2007 F LUKENS DDS TERRANCE M SiteID: 015-021-000840 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 01/18/2000 ~ INSTRUCTION OF ALL PERSONNEL IN HANDLING AND MAINTAINENCE. GAS IS RESTRAINED PROPERLY & VALVED PROPERLY. Release Containment 01/18/2000 PROTABLE PRESSURIZED CONTAINER. Clean Up GASES ONLY. 01/18/2000 V1.11Ci tcCSC~uic:~ s-~c:~ivazion -7- 02/02/2007 r F LUKENS DDS TERRANCE M SiteID: 015-021-000840 ~ Fast Format ,~ ~ Site Emergency Factors Overall Site ~ .7~JC1:1d1 IldGdt U~ Utility Shut-Offs 01/18/2000 A) GAS - W SIDE OF BLDG B) ELECTRICAL - W SIDE OF BLDG C) WATER - E SIDE OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHER IN OFFICE. FIRE HYDRANT - 38TH ST 200FT AWAY. 02/02/2007 Building Occupancy Level 03/02/2006 7 EMPLOYEES z -8- 02/02/2007 Z '~ F LUKENS DDS TERRANCE M SitelD: 015-021-000840 ~ Fast Format ~ ~ Training Overall Site ~ Employee Training 12/14/2006 MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUNIlKARY OF TRAINING PROGRAM: ALL EMPLOYEES ARE TRAINED IN HOW TO MAINTAIN AND SHUT OFF ALL COMPRESSED GASSES. INCASE OF ANY WARNING OF FIRE, IE, SMOKE, ETC, ALL GASSES ARE CHECKED TO MAKE SURE THEY ARE SHUT OFF. THEY ARE KEPT SHUT OFF EXCEPT WHEN IN USE. rctyv ~ _~~ r_ 11G ilA 1V1 i"lA ~. {.LLC Vw7G nClu 1Vl ru~uic Vw7C -9- 02/02/2007 e, ~ - + LUKENS DDS TERRANCE M _______________________________ SiteID: 015-021-000840 + Manager Location: 3807 SAN DIMAS .ST 13 City BAKERSFIELD BusPhone: (661) 327-0835 Map 103 CommHaz High Grid: 19B FacUnits: 1 AOV: CommCode: BFD STA 04 SIC Code: EPA Numb : ~,~L O DOS q ~ G ~~ DunnBrad Emergency Contact / Title Emergency Contact / Title TERRANCE LUKENS DDS / OWNER ROBERT LUKENS MD / OWNERS FATHER Business Phone: (661) 327-0835x Business Phone: (661) 327-0835x 24-Hour Phone (661) 87.2-1014x 24-Hour Phone (661) 325-2382x Pager Phone ( Got) ~~~ - d(~g~x Pager Phone ( ) - x Hazmat Hazards: Fire Press React ImmHlth .. Contact TERRANCE M LUKENS DDS Phone: (661) 327-0835x MailAddr: 3807 SAN DIMAS ~ST 13 State: CA City BAKERSFIELD Zip 93301 Owner TERRANCE M LUKENS DDS Phone: (661) 327-0835x Address 12101 CATTLE KIIaTG DR State: CA City BAKERSFIELD Zip 93306 _ . Period ~ c~ ._ .~. .to _. -.: .. - TotalASTs:. .- ~__ :..: ... Gal.. Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: ~~ Emergency Directives: ~ PROG A - HAZMAT PROG H - HAZ WASTE GEN ~NT`~ f~A~ ~ 7 206 Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of aw tha4 1 have personally examined and familiar with the information submitt~ci an ieve the information is true, accu 'a , i ~ ~Nicic. Sig ature Date -1- 03/03/2006 h ~r LUKENS-DDS TERRANCE M SiteID: 015-021-000840 Manager TERRANCE M LUKENS Location: 3807 SAN DIMAS ST B City BAKERSFIELD BusPhone: (661) 327-0835 Map 103 CommHaz High Grid: 19B FacUnits: 1 AOV: CommCode: BFD STA 04 EPA Numb: CAL000099067 SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title DEBBIE LARAMORE / / Business Phone: (661) 327-0835x Business Phone: ( ) - x 24-Hour Phone (661) 631-8790x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact TERRANCE M LUKENS Phone: (661) 327-0835x MailAddr: 3807 SAN DIMAS ST B State: CA City BAKERSFIELD Zip 93301 Owner TERRANCE M LUKENS DDS Phone: (661) 327-0835x Address 12101 CATTLE KING DR State: CA City BAKERSFIELD Zip 93306 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT E~IT'D J U L 1$ X007 E~~~.sed on my inquiry of thane individu29s resp nsibie fic;r o~t~=;fining the i;~forrnation, ! c;,~rtify under pen~:',ty ar°° la°.rr .hat I have persarse9ly examined ~,nd ~!m -,~r~iiar ~nrith the bnforr;-iation submitt~ -+ anr' h ,~ ~ ~ e the intormatian is true, aceurat~ a~,d c~,rr,r,~~te. ~ Si gr cur Date ~ D C~~~ U -1- 07/12/2007 F LUKENS DDS TERRANCE M SiteID: 015-021-000840 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE OXYGEN F P ~ F P IH IH G G 562.00 281.00 FT3 FT3 Hi Low -2- 07/12/2007 -3- 07/12/2007 F LUKENS DDS TERRANCE M SiteID: 015-021-000840 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME NITROUS OXIDE Days On Site 365 Location within this Facility Unit Map: Grid: S OF BACK DOOR INSIDE BLDG AND E END OF BLDG CAS# HALL WALL NEXT TO RECEPTION DOOR ~GasATE T TYPE T PRESSURE TEMPERATURE CONTAINER TYPE I Pure I Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 300.00 FT3 562.00 FT3 300.00 FT3 - ~ tiHGf~tC1JVU5 1.V1~lYV1Vl:,1V1J %Wt. RS CAS# 100.00 Nitrous Oxide No 10024972 t1HGHKL H~JL",JJ1Y11;1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: S OF BACK DOOR INSIDE BLDG AND E END OF BLDG CAS# HALL WALL NEXT TO RECEPTION DOOR 7782-44-7 ~GasATE TPureE ~-AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 281.00 FT3 281.00 FT3 281.00 FT3 L1L~iGt'1CCLVlJ .7 l.Vl°lYV1V rJ1V 1.7 %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 I3tiLiEiiCL Hi J .7 JJ.7 J1"1P~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -4- 07/12/2007 F LUKENS DDS TERRANCE M SiteID: 015-021-000840 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 01/18/2000 ~ CALL 911. Employee Notif./Evacuation 03/27/2006 CALL 911, NORMAL EVACUATION AND SHUT-DOWN OF SYSTEM. Public Notif./Evacuation 03/27/2006 IN CASE OF FIRE, BLDG EVACUATED, GASES SHUT OFF (USUALLY OFF), ALL EMPLOYEES TRAINED IN EVAUUATION AND IN PROPER EMERGENCY PROCEDURES,IE, FIRE EXTINGUISHER, GAS VALVES SHUT-DOWN, CPR, ETC. Emergency Medical Plan 05/09/2007 NEAREST HOSPITAL - MEMORIAL, 420 34TH ST, 327-1792. -5- 07/12/2007 F LUKENS DDS TERRANCE M SiteID: 015-021-000840 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 01/18/2000 ~ INSTRUCTION OF ALL PERSONNEL IN HANDLING AND MAINTAINENCE. GAS IS RESTRAINED PROPERLY & VALVED PROPERLY. Release Containment 01/18/2000 PROTABLE PRESSURIZED CONTAINER. Clean Up 01/18/2000 GASES ONLY. V1.11C1 1CC~VULC:C t]Ul.1Vdl.lVil -6- 07/12/2007 ,, F LUKENS DDS TERRANCE M SitelD: 015-021-000840 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ a~JCC:1d1 rid'GcLi. U~ Utility Shut-Offs 05/09/2007 GAS - W SIDE OF BLDG ELECTRICAL - W SIDE OF BLDG WATER - E SIDE OF BLDG Fire Protec./Avail. Water 02/02/2007 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHER IN OFFICE. FIRE HYDRANT - 38TH ST 200FT AWAY. Building Occupancy Level 03/02/2006 7 EMPLOYEES -7- 07/12/2007 . ;• F LUKENS DDS TERRANCE M SiteID: 015-021-000840 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 12/14/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: ALL EMPLOYEES ARE TRAINED IN HOW TO MAINTAIN AND SHUT OFF ALL COMPRESSED GASSES. IN CASE OF ANY WARNING OF FIRE, IE, SMOKE, ETC, ALL GASSES ARE CHECKED TO MAKE SURE THEY ARE SHUT OFF. THEY ARE KEPT SHUT OFF EXCEPT WHEN IN USE. Ydy C G AClU 1V1 PUI. UlC VSC 1ZC 1~.L 1V1 t'LLl.. U1C V5C -8- 07/12/2007 ~l~ - - Prevention Services UNIFIED PROGRAM INSPECTION~CHECKLIST ,. A. F R S F, ,.,, 9ooTruxtunAve., Suite2lo Fiae Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program aerM t Tel.: (661) 326-3979 ~~ Fax: (661) 872-2171 FACILITY NAME INSPEC T lOIy ATE INSPECTION TIME L~~r-.RNs ~ , `1 ~ //o[(/~'~ ADDRESS . 3~0 ~ s~- ~, ~ ~ ~ ~ PHONE NO~-~ ~ ~ ~ NO OF EMPLOYEES ~ , , ~ o s 2 ~ FACILITY CONTACT - - ~ ~ BUSINESS ID NUMBER - - _ 15-021-0 ~-s ~ ©2 l-' o00 Section 1: Business Plan and Inventory Program ^ ROUTINE ~ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ /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 AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~ ~Q " D ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^YES .~~VNO EXPLAIN: 34 ~ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 - Inspector (Please Print) Fire Prevention/ 1~' In /Shift of Site/Station # Business Site /Responsible Party (Please Print) - White -Prevention Services Yellow -Station Copy Pink =Business Copy _ - - FD 2155 (Rev. 09/05