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Home My WebLink AboutBUSINESS PLANi ,a ~~~,~~~ :I11 f~1 :~' . C57 ~9 ~S7 ~~ ~~ ~.. ~~ r ~~~~f~l ® ®~. ~, o, .~ ~: ~ • ® e ~a ~ ~,~, SEp g 2003 ~-~ .~ oQ ~~~ ~ ~ ~ ~~ o ~, ~~ ~~ ~ iiA151:K YL~K1V1A1~IL+"1V'1'E' ~ ~ ~ u ~ 3301-3501 STOCKDALE HWY. ~ V ~ -- ~ - - -- - l(~ kAISER PERN~~NT~,E SiteID: 015-021-000117 Manager BusPhone: (661) 1 Location: 3501 STOCKDALE HWY Map 123 CommHaz Low City BAKERSFIELD Grid: 02B FacUnits: 1 AOV: CommCode: BFD STA 07 SIC Code:8011 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title RICK FERRELL / D EPT ADMIN SANDY RYAN / DEPT ADMIN Business Phone: (661) 398-5027x Business Phone: (661) 827-3094x 24-Hour Phone ( ) - x 24-Hour Phone (661) 867-2588x Pager Phone (661) `'`'^ ""~°- Pager Phone (661) 634-7242x Hazmat Hazards: Fire Press React ImmHlth Contact : --~i•E~ ~~ l ~~~ Phone : ( 661) ~9~8--5~6~ MailAddr: PO BOX 12099 State: CA City BAKERSFIELD Zip 93389-2099 Owner KAISER PERMANENTE Phone: (661) 398-5000x Address 393 E WALNUT ST State: CA City PASADENA Zip 91188 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN X17 EN I ~D J U ~ e7 ~ ~~JQ~ Oared on my Inquiry of those individuals !certify mation i respr.,nsit~lc ;~~r , r obtaining the have personally s atin t unifier penalt" of examiried ar.a am ~' ~ ar with the information su~amitt .~i ;as,~ yt ve the information is true, accu . p, and .rriplete. ~' / .~~ 4 ,re D~te -1- 07/12/2007 F KAISER PERMANENTE SiteID: 015-021-000117 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN WASTE FIXER F P IH G R L 770.00 5.00 FT3 GAL Low Min -2- 07/12/2007 -3- 07/12/2007 F kAISER PERMANENTE SiteID: 015-021-000117 ~ ~ 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: CLEAN UTILITY RM CAS# 7782-44-7 STATE T TYPE PRESSURE TEMPERATURE CONTAINER TYPE ~GaS I Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 350.00 FT3 770.00 FT3 770.00 FT3 t1E~GEittL V U 5 lL V 1~1Y V1V J_'ilV 1 %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 ri1~G1~KL HS~J;Ja1~1L'1V1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: RADIOLOGY DARKROOM CAS# Liquid TWaste -~mbRient~E ~ AmbientT~E ^~STOICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 3.00 GAL HA ZARDOUS COMPONENTS %Wt. RS CAS# Silver No 7440224 r1C~L~r1LCL tii J JP~~J.71•1L'1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 07/12/2007 F KAISER PERMANENTE SiteID: 015-021-000117 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 05/20/1998 ~ CALL FIRE DEPT AND NOTIFY ADMIN OFFICE. Employee Notif./Evacuation USE PAGING SYSTEM AND LOCK DOOR TO ROOM. 05/20/1998 Public Notif./Evacuation USE PAGING SYSTEM AND EVACUATION MAPS THROUGHOUT THE FACILITY. 03/02/2007 Emergency Medical Plan 10/04/1990 DOCTOR AT FACILITY IF REQUIRED. -5- 07/12/2007 F KAISER PERMANENTE SiteID: 015-021-000117 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 11/16/2000 ~ KEEP OXYGEN TANKS CHAINED TO WALL. BAG ALL INFECTIOUS WASTE AND STORE IN LOCKED ROOM. Release Containment 03/02/2007 N/A Clean Up DISINFECTANT AND MOP OR SPONGE. 10/04/1990 V1.11G1 .nc~vui ~.c tat. l.lva~.lvll -6- 07/12/2007 F KAISER PERMANENTE SiteID: 015-021-000117 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ _, ,_ .~~c~.a.al. naaaiua Utility Shut-Offs 03/02/2007 GAS - REAR BY LOADING FOR PHARMACY ELECTRICAL - ELECT RM AT REAR WATER - FRONT AT ST W/LRG ABOVEGROUND VALVE Fire Protec./Avail. Water 12/20/2006 PRIVATE FIRE PROTECTION - SPRINKLERS AND FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - ON- AND OFF-SITE. Building Occupancy Level 12/20/2006 80 EMPLOYEES -7- 07/12/2007 1 ~} F KAISER PERMANENTE SiteID: 015-021-000117 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 12/13/2006 ~ MSDS SHEETS ON FILE AT THIS FACILITY. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE BRIEFED ON PROPER STORAGE AND HANDLING. ONLY CERTAIN EMPLOYEES HANDLE QUANTITIES THAT ARE MINIMAL. JUST VACATE THE ROOM AFFECTED. IF PROBLEM DEVELOPS, CALL SUPPLIER OF OXYGEN OR COMPANY WHO PICKS UP MEDICAL WASTE. rayc c. nciu ivi ru~utc u~c nclu ivi ruLULC u~c -8- 07/12/2007 s F KAISER PERMANENTE SiteID: 015-021-000117 Manager SEAN NAVIA Location: 3501 STOCKDALE HWY City BAKERSFIELD CommCode: BFD STA 07 EPA Numb: BusPhone: (661) 327-0281 Map 123 CommHaz Low Grid: 02B FacUnits: 1 AOV: SIC Code:8011 DunnBrad: Emergency Contact / Title Emergency Contact / Title T~-B63Pd~' / DEPT ADMIN " SUSAN FEIL / ASST DEPT ADMIN Business Phone: (661) 398-5027x Business Phone: (661) 827-3690x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone (661) 321-1238x Pager Phone (661) 634-7177x Hazmat Hazards: Fire Press Reac t ImmHlth Contact T_~______ ______ Phone: (661) 398-5070x MailAddr: PO BOX 12099 State: CA City BAKERSFIELD Zip 93389-2099 Owner KAISER PERMANENTE Phone: (661) 398-5000x Address 393 E WALNUT ST State: CA City PASADENA Zip 91188 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ~,~ y.,1 ~~"-%~. ~' ~ PROG H - HAZ WASTE GEN ~'~.~ 1 - 0' ~~.V 7777"'~' " ~~~- Sased on my inquire of thOS~ individuals ible for abta~ning t ~ inforn°sation, I certify ~~'n~ /- p- X27 ( ~P~/ 3~0 ° n J / ~l ~ ~ ~.yd (~(~ - [.~-,3 respons under penalty of 1a r ~ haere personally d and am mill r with the information i ()~ ~ j ~ ,) , Zu ~ ~ 4 F' rl ~c~ ' ~(~ l _ ~p3 y ~ Z ~ ne exam submitted and liev~ he information is true, n mpg e• t e/ ~" ~.f ~ rC ~- /(/ 7 ' ~ a accura !'"„ r ign ure Date ENt~ ~ -~ ~-~ ~ ~ ~ ,~q R ~ ~QO 7 ~ .. ~Sc~ l~,c ~~~~..zs r -1- ~ ~ ~ ~- Div _ ~~7 ~ ~~, Z. 02/01/2007 F ~- i ,, F KAISER PERMANENTE SiteID: 015-021-000117 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ ^Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN WASTE FIXER F P IH G R L 770.00 5.00 FT3 GAL Low Min -2- 02/01/2007 -3- 02/01/2007 SiteID: 015-021-000117 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 7782-44-7 STATE -TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas TPure -Above Ambient Ambient PORT. PRESS. CYLINDER ~; r, F KAISER PERMANENTE ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME OXYGEN Location within this Facility Unit CLEAN UTILITY RM AMOUNTS AT THIS LOCATION .Largest Container Daily Maximum Daily Average 350.00 FT3 770.00 FT3 770.00. FT3 riAG1~tC1JV U.7 1.V1~lYV1V L' 1V 1 J °sWt. RS CAS# 100.00 Oxygen, Compressed No 7782447 t11'iGHttL Ei.7.~. L' S51~1~1V 1 w`! TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT#$ MCP No No No No/ Curies F P IH / / / Low ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME j CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: RADIOLOGY DARKROOM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TWaste ~ Ambient ~ Ambient -~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 3.00 GAL riAGt~tCLV U.7 1:V1~lYV1V L' 1V 1.7 °sWt . RS CAS# Silver No 7440224 r1H~titu~ HSa~~~l~ilJiv t 5 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 02/01/2007 ~t ' . F KAISER PERMANENTE SiteID: 015-021-000117 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 05/20/1998 I CALL FIRE DEPT AND NOTIFY ADMIN OFFICE. Employee Notif./Evacuation 05/20/1998 USE PAGING SYSTEM AND LOCK DOOR TO ROOM. - rI.LLJl lI, 1VV 1..11. ~ L' VCLI: UClL1V11 ~c ~ ~~~~~ Emergency Medical Plan 10/04j1990 DOCTOR AT FACILITY IF REQUIRED. -5- 02/01/2007 F KAISER PERMANENTE SiteID: 015-021-000117 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 11/16/2000 ~ KEEP OXYGEN TANKS CHAINED TO WALL. BAG ALL INFECTIOUS WASTE AND STORE IN LOCKED ROOM. Release Containment a/~- Clean Up DISINFECTANT AND MOP OR SPONGE. 10/04/1990 Other Resource Activation -6- 02/01/2007 1~ F KAISER PERMANENTE SiteID: 015-021-000117 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ oNc~.s.ai na~aiu~ Utility Shut-Offs 12/13/2006 A) GAS - REAR BY LOADING FOR PHARMACY B) ELECTRICAL - ELECT RM AT REAR C) WATER - FRONT AT ST W/LRG ABOVEGROUND VALVE D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 12/20/2006 PRIVATE FIRE PROTECTION - SPRINKLERS AND FIRE EXTINGUISHERS. NEAREST FIRE HYDRANT - ON- AND OFF-SITE. Building Occupancy Level 12/20/2006 80 EMPLOYEES -7- 02/01/2007 F KAISER PERMANENTE SiteID: 015-021-000117 ~ Fast Format ~ ~ T"raining Overall Site ~ Employee Training 12/13/2006 ~ ~MSDS SHEETS ON FILE AT THIS FACILITY. BRIEF SUNIMARY OF TRAINING PROGRAM: EMPLOYEES ARE BRIEFED ON PROPER STORAGE AND HANDLING. ONLY CERTAIN EMPLOYEES HANDLE QUANTITIES THAT ARE MINIMAL. JUST VACATE THE ROOM AFFECTED. IF PROBLEM DEVELOPS, CALL SUPPLIER OF OXYGEN OR COMPANY WHO PICKS UP MEDICAL WASTE. ruyC ~ nciu ivi ru~uic vac nciu iv.L ru~uic v5C -8- 02/01/2007 Family Practice Phosphate Buffers 36% Formaldehyde, 10% Formalin Methanol, 02 X 30m1 27 4 3/4 Acetone CH3, COCH3 X Highly Flammable Adhesive Tape Remover Inhalation-may cause dizzines, headache X 4 fl oz 10 2 2/2 Alcohol Skin Cleaner H2O, Carbon Dioxide, Alcohol X 18 oz 20 1 3/1 Ammonia Ampules Ammonia, Ethylalcohol X 10 amps/Box 8 3 2/3 Asepti Wipe II Propan-zol X 18 oz 9 1 0/2 Baxter Enzymatic Cleaner X Gallon 2 1 4/1 Cytology Fixture Spray X 3.5 oz 1.0 Flammable Delasco Trichloroacetic Acid Aqueous Solution Carbon monoxide, Chloroform, Hydrogen Chloride X Enzy Clean Flori-Methane Carbonyl Halides, Hydrogen Chloride, Hydrogen Floride X 3.5 oz 2 1 1/1 Gluco-Chlor Sodium Hypochlorite (bleach) hypochlorous Acid, Sodum Salt X 100 towelettes' /Box 4 1 0/2 H2O2- (Hydrogen Peroxide) Strong Oxidizer, Poison, Danger, Corosive X 16 oz 5 2 1/1 Iodine X 16 fl oz 3 0 0/2 Jessner's Solution Lactic in Ethanlol, Salialic Acid, Resorcinol X Liquid Enzyme Cleaner Subtilisin protease enzyme, Propylene ghyael X gallon 2 1 0/2 Liquid Nitrogen X 5 liters 1 2 2/0 Liquid Phenol Carbolic Acid, liquified X 120 ml 2 3 2/0 i Acid Acid Acid Acid Acid Acid Acid Acid Neutral Acid Corr Monsel's Ferric Subsulfate Solution X 3.5 oz 1 1 0/0 Oxygen - X E Cylinder 9 0 4/0 Povidone Iodine Scrub X 30 box 1 Potassium Hydroxide (KOH) Dimethylsufoxide 58%, Potassium Hydroxide X 2 fl oz 6 3 0/1 Silvadene Cream 1 % X 100 gm jar Silver Nitrate Applicators X 100 sticks/can 2 0 1/0 Tinctore Benzoin Compound Ethanol X .67 ml 200 Acid Corr Neutral Low Podiatry Phosphate Buffers 36% Formaldehyde, 10% Formalin Methanol, 02 X ' 30m1 27 4 3/4 Acetone CH3, COCH3 X Highly Flammable Acid Aqueaus Solution Carbon monoxide, Chloroform, Hydrogen Chloride X Adhesive Tape Remover Inhalation-may cause dizzines, headache X 4 fl oz 10 2 2/2. Alchohol Isopropyl X 16 fl oz 8 3 4/1 Alcohol Skin Cleaner H2O, Carbon Dioxide, Alcohol X 18 oz 20 ~ 1 3/1 Ammonia Ampules Ammonia, Ethylalcohol X 10 amps/Box 8 3 2/3 Asepti Wipe II ~ Propan-zol X 18 oz 9 1 0/2 Baxter Enzymatic Cleaner X Gallon 2 1 4/1 Benzoin Tunctune Ethanol X .67 ml 200 Cytology Fixture Spray X 3.5 oz 10 Flammable Delasco TrichloroaceticRcid Aqueous Solution Carbon monoxide, Chloroform, Hydrogen Chloride X Enzy Clean Flori-Methane Carbonyl Halides, Hydrogen Chloride, Hydrogen Floride X 3.5 oz 2 1 1/1 Gluco-Chlor Sodium Hypochlorite (bleach) hypochlorous Acid,. Sodum Salt X 100 towelettes /Box 4 1 0/2 H2O2- (Hydrogen Peroxide) Strong Oxidizer, Poison, Danger, Corosive X 16 oz 5 2 1/1 Hibiclense Iodine X 16 fl oz 3 0 0/2 P!~b~ P!~d P!~`d P!~`d P!~`d P!~t/ P!~`d P!~`d P!~H Jessner's Solution Lactic in Ethanlol, Salialic Acid, Resorcinol X Liquid Enzyme Cleaner Subtilisin protease enzyme, Propylene ghyael X gallon 2 1 0/2 Liquid Nitrogen X 5 liters 1 2 2/0 Liquid Phenol Carbolic Acid, liquified X 120 ml 2 3 2/0 Monsel's Ferric Subsulfate Solution X 3.5 oz 1 1. 1/1 Oxygen X E-Cylinder 9 0 4/0 Potassium Hydroxide (KOH) Dimethylsufoxide 58%, Potassium Hydroxide X 2 fl oz 6 3 0/1 Povidone Iodine Scrub X 30 box 1 Silvadene Cream 1 % X 100 gm jar Silver Nitrate Sticks ~ X 100 stick/can 2 0 1/0 Tinctore Benzoin Compound Ethanol X .67 ml 200 Neutral Acid Corr Acid Corr Neutral Very Low :cupational Medicine/Intenal Medic 10% Formalin ne Phosphate Buffers 36% Formaldehyde, Methanol, 02 X 30m1 27 4 3/4 Acid Adhesive Tape Remover Inhalation-may cause dizzines, headache X 4 fl oz 10 2 2/2 Acid Alchohol Isopropyl X 16 fl oz 8 3 4/1 Acid Alcohol Skin Cleaner H2O, Carbon Dioxide, Alcohol X 18 oz 20 1 3/1 Acid Ammonia Ampules Ammonia, Ethylalcohol X 10 amps/Box 8 3 2/3 Acid Ammonia Inhalent Solution Amonia, Ethyl, Alcohol X 10 amps/Box 8 ~ 3 3/3 Asepti Wipe II Propan-zol X 18 oz 9 1 0/2 Baxter Enzymatic Cleaner X Gallon 2 1 4/1 Cytology Fixture Spray X 3.5 oz 10 Flammable Flori-Methane Carbonyl Halides, Hydrogen Chloride, Hydrogen Floride X 3.5 oz 2 1 1/1 Acid Gluco-Chlor Sodium Hypochlorite (bleach) hypochlorous Acid, Sodum Salt X 100 towelettes /Box 4 1 0/2 Acid H2O2- (Hydrogen Peroxide) Strong Oxidizer, Poison, Danger, Corosive X 16 oz 5 2 1/1 Iodine X 16 fl oz 3 0/2 Acid Liquid Enzyme Cleaner ~ Subtilisin protease enzyme, Propylene ghyael X gallon 2 1 0/2 Neutral Liquid Nitrogen X 5 liters 1 2 2/0 Liquid Phenol Carbolic Acid, liquified X 120 ml 2 3 2/0 Acid Oxygen X E Cylinder 9 0 4/0 L U Povidone Iodine Scrub X Silvadene Cream 1 % X 100 gm jar Neutral Tinctore Benzoin Compound Ethanol X .67 ml 200 Very Low ~J_JJ Internal Medicine 10% Formalin Phosphate Buffers 36% Formaldehyde, Methanol, 02 X 30m1 27 4 3/4 Acetone CH3, COCH3. X Highly Flammable Adhesive Tape Remover Inhalation-may cause dizzines, HA's X 4 fl oz 10 2 2/2 Alcohol Isopropyl 16 oz 8 3 4/1 Alcohol Skin Cleaner H2O, Carbon Dioxide, Alcohol X 18 oz 20 1 3/1 Ammonia Ampules Ammonia, Ethylalcohol X 10 amps/Box 8 3 2/3 Ammonia Inhalent Solution Amonia, Ethyl, Alcohol X 10 amps/Box 8 3 3/3 Asepti Wipe II Propan-zol X 18 oz 9 1 0/2 Baxter Enzymatic Cleaner X Gallon 2 1 4/1 Cytology Fixture Spray X 3.5 oz 10 Flammable Delasco Trichloroacetic Acid Aqueous Solution Carbon monoxide, Chloroform, Hydrogen Chloride X Flori-Methane Carbonyl Halides, Hydrogen Chloride, Hydrogen Floride X 3.5 oz 2 1 1/1 Gluco-Chlor Sodium Hypochlorite (bleach) hypochlorous Acid, Sodum Salt X 100 towelettes /Box 4 1 0/2 H2O2- (Hydrogen Peroxide) Strong Oxidizer, Poison, Danger, Corosive X 16 oz 5 2 1/1 Iodine X 16 fl oz 3 0/2 Jessner's Solution Lactic in Ethanlol, Salialic Acid, Resorcinol X Liquid Enzyme Cleaner Subtilisin protease enzyme, Propylene ghyael X gallon 2 1 0/2 Liquid Nitrogen X 5 liters 1 2 2/0 Acid Acid Acid Acid Acid Acid Acid Acid Neutral _. Liquid Phenol Carbolic Acid, liquified X 120 ml 2 3 2/0 Monsel's Ferric Subsulfate Solution X 3.5 oz 1 1 1/1 Oxygen X E Cylinder 9 0 4/0 Potassium Hydroxide (KOH) Dimethylsufoxide 58%, Potassium Hydroxide X 2 fl oz 6 3 0/1 Povidone Iodine Scrub X Silvadene Cream 1 % X 100 gm jar Silver Nitrate Applicators X 100 sticks/can 2 0 1/0 Tinctore Benzoin Compound Ethanol X .67 ml 200 ~. Acid Corr Acid Corr Neutral Very Low f}' ~ Same Day Clinic 10% Formalin Phosphate Buffers 36% Formaldehyde, Methanol, 02 X 30m1 27 4 3/4 Acetone CH3, COCH3 X Highly Flammable Adhesive Tape Remover Inhalation-may cause dizzines, headache X 4 fl oz 10 2 2/2 Alchohol Isopropyl X 16 fl oz 8 3 4/1 Alcohol Skin Cleaner H2O, Carbon Dioxide, Alcohol X 18 oz 20 1 3/1 Ammonia Ampules Ammonia, Ethylalcohol X 10 amps/Box 8 3 2/3 Asepti Wipe II Propan-zol X 18 oz 9 1 0/2 Baxter Enzymatic Cleaner X Gallon 2 1 4/1 Cytology Fixture Spray X 3.5 oz 10 Flammable Delasco TrichloroaceticRcid Aqueous Solution Carbon monoxide, Chloroform, Hydrogen Chloride X Flori-Methane Carbonyl Halides, Hydrogen Chloride, Hydrogen Floride X 3.5 oz 2 1 1/1 Gluco-Chlor Sodium Hypochlorite (bleach) hypochlorous Acid, Sodum Salt X 100 towelettes /Box 4 1 0/2 H2O2- (Hydrogen Peroxide) Strong Oxidizer, Poison, Danger, Corosive X 16 oz 5 2 1/1 Iodine X 16 fl oz 3 0 0/2 Jessner's Solution Lactic in Ethanlol, Salialic Acid, Resorcinol X Liquid Enzyme Cleaner Subtilisin protease enzyme, Propylene ghyael X gallon . 2 1 0/2 Liquid Nitrogen X 5 liters 1 2 2/0 Liquid Phenol Carbolic Acid, liquified X 120 ml 2 3 2/0 r~ Acid Acid Acid Acid Acid Acid Acid Acid Acid Neutral Acid Corr Monsel's Ferric Subsulfate Solution X 3.5 oz 1 1 1/1~ Oxygen X E Cylinder 9 0 4/0 Potassium Hydroxide (KOH) Dimethylsufoxide 58%, Potassium Hydroxide X 2 fl oz 6 3 0/1 Povidone Iodine Scrub X 30 box 1 Silvadene Cream 1 % X 100 gm jar Silver Nitrate Applicators X 100 sticks/can 2 0 1/0 Tinctore Benzoin Compound Ethanol X .67 ml 200 .k Acid Corr Neutral Very Low f Dermatology 10% Formalin Phosphate Buffers 36% Formaldehyde, Methanol, 02 X 30m1 27 4 3/4 Acid Acetone CH3, COCH3 X - Highly Flammable Acid Adhesive Tape Remover Inhalation-may cause dizzines, headache X 4 fl oz 10 2 2/2 Acid Alchohol Isopropyl X 16 fl oz 8 3 4/1 Acid Alcohol Skin Cleaner H2O, Carbon Dioxide, Alcohol X 18 oz 20 1 3/1 Acid Ammonia Ampules Ammonia, Ethylalcohol X 10 amps/Box 8 3 2/3 Acid Asepti Wipe II Propan-zol X 18 oz 9 1 0/2 Baxter Enzymatic Cleaner X Gallon 2 1 4/1 Cytology Fixture Spray X 3.5 oz 10 Flammable Delasco Trichloroacetic Acid Aqueous Solution Carbon monoxide, Chloroform, Hydrogen Chloride X Flori-Methane Carbonyl Halides, Hydrogen Chloride, Hydrogen Floride X 3.5 oz 2 1 1/1 Acid Gluco-Chlor Sodium Hypochlorite (bleach) hypochlorous Acid, Sodum Salt X 100 towelettes /Box 4 1 0/2 Acid Iodine X 16 fl oz 3 0 0/2 Acid Jessner's Solution Lactic in Ethanlol, Salialic Acid, Resorcinol X Liquid Enzyme Cleaner Subtilisin protease enzyme, Propylene ghyael X gallon 2 1 0/2 Neutral Liquid Nitrogen X 5 liters 1 2 2/0 Liquid Phenol Carbolic Acid, liquified X 120 ml 2 3 2/0 Acid Monsel's Ferric Subsulfate Solution X 3.5 oz 1 1 1/1 Acid ~, ;,._ 0 U -~ Oxygen X E Cylinder 9 0 4/0 Potassium Hydroxide (KOH) Dimethylsufoxide 58%, Potassium Hydroxide X 2 fl oz 6 3 0/1 Povidone Iodine Scrub X 30 box 1 Silvadene Cream 1% X 100 gm jar Neutral Silver Nitrate Applicators X 100 sticks/can 2 0 1/0 Squaric Acid X 0 2 1/E Tinctore Benzoin Compound Ethanol X .67 ml 200 ~ Very Low r, \~ ~ O U Pediatrics 10% Formalin Phosphate Buffers 36% Formaldehyde, Methanol, 02 X 30m1 27 4 3/4 Acid Adhesive Tape Remover Inhalation-may cause dizzines, headache X 4 fl oz 10 2 2/2 Acid Alchohol Isopropyl X ~ 16 fl oz 8 3 4/1 Acid Ammonia Ampules Ammonia, Ethylalcohol X 10 amps/Box 8 3 2/3 Acid Asepti Wipes II Propan-zol X 18 oz 9 1 0/2 Baxter Enzymatic Cleaner X Gallon 2 1 4/1 Cytology Fixture Spray X 3.5 oz 10 Flammable Flori-Methane Carbonyl Halides, Hydrogen Chloride, Hydrogen Floride X 3.5 oz 2 1 1/1 Acid Gluco-Chlor Sodium Hypochlorite (bleach) hypochlorous Acid, Sodum Salt X 100 towelettes 4 1 0/2 Acid H2O2- (Hydrogen Peroxide) Strong Oxidizer, Poison, Danger, Corosive X 16 oz 5 2 1/1 Iodine X 16 fl oz 3 0 0/2 Acid Liquid Nitrogen X 5 liters 1 2 2/0 Liquid Phenol Carbolic Acid, liquified X 120 ml 2 3 2/0 Acid Oxygen X E Cylinder 9 0 4/0 Tinctore Benzoin Compound Ethanol X .67 ml 200 Very Low y~i BAKERSFIELD FIRE DEPT UNIFIED PROGRAM INSPECTION CIiECKLIST ~ » s P, D Prevention Services { ~~RS 900 Truxtun Ave., Suite 210 ~_ ~..-,.<,~s, ~Y.. _:, ~~~.,..,.: ..,.> ~~..:.~ .,{:..... , . k.,,,-.:.. .., ~. < ,:., ..: aRrur s Bakersfield, CA 93301. SECTION 1: Business Plan and Inventory Prograrri Tel.: (661) 326-3979 • Fax: (661) 872-2171 FACILITY N E ~ ~ NSPEC ION DA ~,~ Df~ Dlp INSPECTION.TIME 50 ~~ ADDRESS/®' ~~~~ S ON O. 3z~-vZ~ OO EMPLOYEES ~~ FACILITY CONTACT SINESS ID NUMBER 15-021- V~b ~ ~~ Section 1: Business Plan and Inventory Program ~~D ^ ROUTINE .COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION • C V (c=Compliance OPERATION V=Violation COMMENTS _ _____ ^ APPROPRIATE PERMIT ON HAND ^ BUSIfI@SS PLAN CONTACT INFORMATION ACCURATE ~ 1- C ~ f") J ~./ ^ VISIBLE ADDRESS ~D ^ 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 CEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE 8 ON HAND ANY HAZA DOUS ~ ASTE ON SITET YES ^ NO XPLAIN: ~ - -__-_ •QUES~!?NSREG/~tFZDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1°' In /Shift of Site/Station # White -Prevention Services Yellow -Station Copy pink -Business Copy FD2049 (Rav. 02/05) + KAISER PERMANENTE ___________________________________ SiteID: 015-021-000117 + Manager SEAN NAVIA Location: 3501 STOCKDALE HWY City BAKERSFIELD BusPhone: (661) 327-0281 Map 123 CommHaz Low Grid: 02B FacUnits: 1 AOV: CommCode: BFD STA 07 EPA Numb: SIC Code:8011 DunnBrad: Emergency Co-n~rt~a~ct / '~"itle Emergency Contact / Title ', ~T:-z:n`,rT'~ 1 ~ 1 J/-25 / L7U i%l S i7~~ 141~Y/1 .'~ ~11~2Ln /-i'~2i [, ~"~~ ~ ~ --~z sn ~. ~ ~ f~s~~ l~ Business Phone: (661) - 3~P~-5~a Business Phone: (661) .e2'~-^?O'_° ~L7-3 ~c+ 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ~ ~ ~) '3'Z I - 12 3 S/ x Pager Phone ( (~ ( ) ~~ - 7 (~ ~x Hazmat Hazards: Fire Press React ImmHlth Contact ~ i'1T1TVi TTT[TTT ~, ~ Phone : ( 661 ~ ^' -~'1'' -°- r.~. .n, ~~ ~o I~t S Ito . MailAddr: PO BOX 12099 State: CA ~%p(p I~~tb~~5~'7C~ City BAKERSFIELD Zip 93389 ~'1330~ Owner KAISER PERMANEN~"E Address 393 E WALNUT ST City PASADENA Phone: (661) 398-5000x State: CA Zip 91188 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN -~, ~- ~j ~~ . i ~~, / Based on m in responsiblQ for obtaining the information, i i ertify ~~ under penalty of law that I have personally examined and am familiar with the information submitted and b Have the information is true, a . gate, and co Iete. Da~S ~,-b r'' ~N~9~ ,~ ~~ ~ ~ ~~~~ J `~ .•` . " -1- 03/09/2006 UNIFIED PROGRAIUI INSPECTION CHECKLIST` ~X,~..:~~'tti1~'.~AS9kaG4'.%'3......,.r'vh.'. r..,a?`S;E :-~. .., r~3'«C?rif,.'. ,nz.ar3. i...... „. ,...... ~ .x,,, ., ~ .- ..,...:., .. .,.. SECTION 1: Business Plan and Inventory Program BAKERSFIELD FIRE DEPT Prevention Services a P r n 900 Truxtun Ave., Suite 210 ~/R/ ARrM t Bakersfield; CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME INSP CTION ATE INS?ECTION TIME FJL uP ~~ b ~ ADDRESS w ~e l ~ ~ ~ r{+A1` S HQ ~ NO. O~ I ii /~ 33 OOH EMPLOYEES 1\ ~ FACILITY C T _ SS D NUMBER U SIN E 15-021- ~~ ~ ~ N Arv I Q-- INS ~ ~ ~ - Section 1: Business Plan and Inventory Program AFC ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTI , ~~' C V ~ C=Compliance O P E R AT I O N V=Violation COMMENT S ^ APPROPRIATE PERMIT ON HAND BUSIfI@SS PLAN CONTACT INFORMATION ACCURATE ~ ~ 1~ ~,J~1 ~ ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ~ _ - ~ C ^ VERIFICATION OF QUANTITIES ~, ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^~ PFiO VERIFICATION OF ABATEMENT SUPPLIES AND URES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ~!~J ~~ ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZAR OUS WA TE ON SITE? EXPLAIN: ~~~~ ~ XE2 = YES ^ NO QUESTIONS REGARDING THIS INSPEC~TIiON? PLEASE CALL US AT (661) 326-3979 i ~v Inspector ease Print) Fire Prevention / 1s' In /Shift of Site/Station tk White -Prevention Services Yellow -Station Copy Pink -Business Copy ;~;. FD2049 (Rev. 02/05) ,~ °' UNIFIED PROGRAM 1..,~PECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME INSPECTION DATE INSPECTION TIME ADORESS PHONE No. No. of Employees FACILITYCONTACT ~ Business ID Number 15-021- pC271 1-j [_C_ ~ Section 1: Business Plan and Inventory Program outine ^ Combined ^ Joint Agency ^Mnlti-Agency ^ Complaint ^ Re-inspection ncel OPERATION Pl V C COMMENTS \V=Voa on ,. ,/ ^ APPROPRIATE PERMIT ON HAND L J , ./ LT ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE i~ ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ V ERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITYE ^ V ERIFICATION OF HAT MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE lid" ^ CONTAINERS PROPERLY LABELED ~ ^ HOUSEKEEPING l~ ^ FIRE PROTECTION ~^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE: ^ YES ^ NO ~i ~QQ~~,`~ EXPLAIN: _ Q--C~ C~~ (i ~ ~UCL~7 '(_ "~/~~C/~ ~~~03~ QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT ~6F)'I ~ 326-3979 .~. ~ - ~~~~- _ _ _ _ ---y3--------- ~ - --------- ~~r~-~-~- ----- Inspector Badge No. Business Site Responsible Party While -Environmental Services Yellow - Statwn Copy Pink - Bu5ine55 Copy ~~--/ .~~.~ ~`~ 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN,AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 09/20/2006 Order Number: 3148648 Dear Regulator, Date Printed and Mailed: 09/28/2006 Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #17721 MARKET #2133 (~ ~,~ 3601 STOCKDALE HIGHWAY ~ ~ Div BAKERSFIELD, CA. 93309 Testing performed: CP sixty day rectifier inspections Dynamic Pressure Source Stage II A/L tests Stage II blockage tests Sincerely, Dawn Kohlmeyer Manager, Field Reporting A SAN JOAQUIN VALLEY AIR POLLUTION CONTROL DISTRICT Dynamic Pressure Source Test Source Information FACILITY PARAMETERS GDF Name and Address 7-ELEVEN #17721 District Inspector Phase II System Type Phase II System Type MARKET #2133 Device Type Used Balance 3601 STOCKDALE HIGHWAY MANOMETER Assist BAKERSFIELD,CA 93309 Hirt Permit # E.O GILBARCO Phase I System Type EVR 2 Point Hasstech Healy Other Coaxial Manifolded? YO or N Date of Last Calibration: 08/07/2006 Type of Test: Wet / Dry Leak Check: Pass / Fail Nozzle Grade Dynamic Back Pressure, Inches H ~ Result 20 CFH 60 CFH 100 CFH 1-EW 4005 ALL 0.13 0.35 0.83 PASS 2-EW 4015 ALL 0.10 0.35 0.89 PASS 3-EW 4005 ALL 0.10 0.35 0.89 PASS 4-EW 4015 ALL 0.10 0.33 0.74 PASS Test Conducted By: Test Company: Date of Test: STEVEN GALLARDO Tanknology 09/20/2006 Signature: Confirmation # Tester Certification # 06-7006 T4015 ~'" ~' Dynamic Pressure { TP 201.4 s ~ ~ ~ Ref. No.: Testing Compan y AQMD Id: Name: Tanknology Site Name: 7-ELEVEN #17721 Address: 41785 Enter rise Circle S. Suite D p Address: MARKET #2133 Temecula, CA 92590 BAKERSFIELD Phone: (951)676-4060 Phone: 661834-3093 Dispenser Product Nozzle Comments Number Grade Mfg/# CFH CFH CFH CFH CFH (0.15) (0.16) (0.35) (0.62) (0.95) 1 ALL EW 4005 0.13 0.35 0.83 PASS 2 ALL EW 4015 0.10 0.35 0.89 PASS 3 ALL EW 4005 0.10 0.35 0.89 PASS 4 ALL EW 4015 0.10 0.33 0.74 PASS 08/07/06 Rotameter calibration date (Annual) 08/07/06 Pressure measuring device calibration date (Annual) 1500 Time of back pressure unit leak check (Prior to each sites' tests) 10.33 Final pressure decay of back pressure unit in 1 minute I List of failed nozzles Tester: STEVEN GALLARDO Tester Id: T4015 Signature: Test Date: 09/20/2006 ~ T'df1/Q'~0/09Y 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:09/20/06 WORK ORDER NUMBER3148648 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #17721 COMMENTS Blockage Testing & 60-Day CP Rectifier Check. Conf.#06-7006, all tests passed, CP Readings 8.3V volts, 1.26A amps PARTS REPLACED QUANTITY DESCRIPTION- HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 09/28/2006 08:19 ACRAMER 1. SITE DIAGRAM ~ Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 09/20/06 WORK ORDER NUMBER3148648 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #17721 • ~ ~ O O ,0 ,O N S ~ ~ 7 REG REG ~ ~~ ~ STP STP N STP 10OAK OV OF PREM CP ~ VENTS Printed 09/28/2006 08:19 ACRAMER