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HomeMy WebLinkAboutBUSINESS PLAN 10/26/2007 ~ MILLENNIUM SURGERY CENTER INC SiteID: 015-021-002213 Manager : KATHLEEN ALLMAN Location: 9300 STOCKDALE HWY 200 City BAKERSFIELD BusPhone: Map : 123 Grid: 05A (661) 663-3700 CommHaz : High FacUnits: 1 AOV: CommCode: BFD STA 11 EPA Numb: SIC Code: DunnBrad: Emergency Contact KATHLEEN ALLMAN Business Phone: 24-Hour Phone Pager Phone / Title / ADMINISTRATOR (661) 663-3700x (661) 319-6999x () x Emergency Contact HIKE BllA..e*fiIeRB- Business Phone: 24-Hour Phone Pager Phone / Title / FACILIY~ COO~ (661) 663-3700x -t6611 436 6626J[ () X Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : t1~Iffi :BLACKFeRfi- ~ LEe.,.J P>.-.L..LM.p.,..1 MailAddr: 9300 STOCKDALE HWY 200 City BAKERSFIELD Period Preparer: Certif'd: ParcelNo: to Phone: (661) 663-3700x State: CA Zip 93311 Phone: (661) 663-3700x State: CA Zip 93311 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Owner Address City MILLENNIUM SURGERY CENTER INC 9300 STOCKDALE HWY 200 BAKERSFIELD Emergency Directives: PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK Based ,?,n ,....,,, inquiry of those in1:v;d:I~'s ; --,...,......,....'v :ur v..ltail,;"!:/ Lile illiulI'Ii:lliufI, I c~nHY unde~ penalty of law, ~hat ~ have personally examl,ned and am familiar with the information submitted and believe the information is true accurate, and complete, ' ~~ IDd{o"Ol 'gnature Date ------ -1- 10/24/2007 Hazmat Common Name... IspeCHazlEPA F P F SiteID: 015-021-002213 9 By Facility Unit 9 Fixed Containers at Site 9 Hazards I Frm I DailyMax IUnitlMCP IH G 1696.00 FT3 Hi IH DH G 3000.00 FT3 Low L 65.00 GAL Low IH G 1332.00 FT3 Min F MILLENNIUM SURGERY CENTER INC p= Hazmat Inventory p== MCP+DailyMax Order NITROUS OXIDE OXYGEN DIESEL NITROGEN F P -2- 10/24/2007 -3- 10/24/2007 F MILLENNIUM SURGERY CENTER INC p= Inventory Item 0002 F= COMMON NAME / CHEMICAL NAME NITROUS OXIDE SiteID: 015-021-002213 9 Facility unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit TANK RM NW CRNR OF BLDG Map: Grid: CAS # 10024-97-2 STATE - TYPE Gas Pure PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 424.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 1696.00 FT3 Daily Average 1696.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Nitrous Oxide No 10024972 HAZARD AS E ME TS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi S SS N p= Inventory Item 0003 F= COMMON NAME / CHEMICAL NAME OXYGEN Facility Unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit TANK RM NW CRNR OF BLDG Map: Grid: CAS # 7782-44-7 STATE - TYPE Gas Pure PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 249.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 3000.00 FT3 Daily Average 3000.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -4- 10/24/2007 F MILLENNIUM SURGERY CENTER INC p= Inventory Item 0004 F= COMMON NAME / CHEMICAL NAME DIESEL SiteID: 015-021-002213 9 Facility Unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit UNDER GENERATOR NW CRNR OF BLDG Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE ABOVE GROUND TANK Largest Container 65.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 65.00 GAL Daily Average 65.00 GAL Z P N N %Wt. RS CAS # 100.00 Diesel Fuel No. 2 No 68476302 HA ARDOUS COM 0 E TS D M N S TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Low HAZAR ASSESS E T p= Inventory Item 0001 Facility Unit: Fixed Containers at Site 9 F= COMMON NAME / CHEMICAL NAME NITROGEN Days On Site 365 Location within this Facility Unit TANK RM NW CRNR OF BLDG Map: Grid: CAS # 7727-37-9 STATE - TYPE Gas Pure PRESSURE ---- TEMPERATURE Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER Largest Container 222.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 1332.00 FT3 Daily Average 1332.00 FT3 ZARDOUS OMPONENTS %Wt. RS CAS # 100.00 Nitrogen No 7727379 HA C HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -5- 10/24/2007 F MILLENNIUM SURGERY CENTER INC I p= Notif./Evacuation/Medical Agency Notification SiteID: 015-021-002213 9 Fast Format 9 Overall Site 9 02/02/2007 EMPLOYEES ARE NOTIFIED WITH ALL CALL ON TELEPHONE SYSTEM. EACH AREA OF THE SUITE CLEARS THEIR AREA OF EMPLOYEES, PATIENTS AND VISITORS. NEIGHBORING SUITES ARE NOTIFIED AS EMPLOYEES LEAVE THE BUILDING. THERE ARE NO NEIGHBORING BUILDINGS. THE SUITE IS MONITORED BY SECURE MONITORING CO 326-1747. Employee Notif./Evacuation 02/02/2007 EMPLOYEE ARE NOTIFIED WITH ALL CALL ON TELEPHONE SYSTEM. EACH AREA OF THE SUITE CLEARS THEIR AREA OF EMPLOYEES, PATIENTS AND VISITORS. NEIGHBORING SUITES ARE NOTIFIED AS EMPLOYEES LEAVE THE BUILDING. THERE ARE NO NEIGHBORING BUILDINGS. THE SUITE IS MONITORED BY SECURE MONITORING CO 326-1747. Public Notif./Evacuation 02/02/2007 EMERGENCY GENERATOR - SEPARATE OUTSIDE BRICK ENCLOSURE. DIESEL GAS STORED ABOVE GROUND. VISUAL LEAK DETECTION PERFORMED, MONITORED, AND DOCUMENTED ON GENERATOR LOG MEDICAL GASES - STORAGE CLOSET OUTSIDE ACCESS NW CORNER OF BUILDING ALARM MONITOR VISUAL AND SOUND. Emergency Medical Plan 02/02/2007 MEDICAL EMERGENCIES ARE ADDRESSED IMMEDIATELY BY COMPLETING WORKERS COMP FORMS AND SENDING EMPLOYEES TO SOUTHWEST URGENT CARE, 6401 TRUXTUN AVE. IF INJURIES ARE SEVERE, EMPLOYEE WILL GO DIRECTLY TO MERCY SOUTHWEST HOSPITAL. -6- 10/24/2007 F MILLENNIUM SURGERY CENTER INC I p= Mitigation/prevent/Abatemt Release Prevention SiteID: 015-021-002213 9 Fast Format 9 Overall Site 9 02/02/2007 KATHLEEN ALLMAN, ADMINISTRATOR, IS RESPONSIBLE FOR NOTIFYING AUTHORITIES, AND ANY RELATED MATTERS. '-M:r~ ~CI{FQRI;) IS SECOND IN COMMAND TO MAKE SURE THAT THE RESPONSILITIES ARE MET. .JGtJr-l1 Pr:::R-~, ~.,w 'B"E Release Containment Clean Up Other Resource Activation -7- 10/24/2007 F MILLENNIUM SURGERY CENTER INC I p= Site Emergency Factors Special Hazards SiteID: 015-021-002213 9 Fast Format 9 Overall Site 9 Utility Shut-Offs Fire Protec./Avail. Water 06/19/2007 SPRINKLER SYSTEM Building Occupancy Level 06/19/2007 67 EMPLOYEES -8- 10/24/2007 . '. ;IlIA F MILLENNIUM SURGERY CENTER INC I p= Training Employee Training SiteID: 015-021-002213 9 Fast Format 9 Overall site 9 06/26/2006 MSDS SHEES ON FILE IN FRONT OFFICE WITH POLICY AND PROCEDURE MANUALS BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE SHOWN WHERE SHUT-OFF VALVES AND EXTINGUISHERS ARE LOCATED. THEY ARE INSTRUCTED WHAT TO DO IN CASE OF A FIRE AND PARTICIPATE IN FIRE DRILLS. ALL EMPLOYEES KNOW WHERE THE MSDS SHEETS ARE LOCATED. MOSTLY IN-SERVICE ADDRESSES SAFETY. THERE ARE QUARTERLY FIRE DRILLS. Page 2 Held for Future Use Held for Future Use -9- 10/24/2007 __ _ _L~_.. Y. ~; MILLENNIUM SURGERY CENTER ~ 9300 STOCI~ALE HWY X200 --- --- - - -- - l i «~ ~~s~ ~. Jar ~; ~ 2QQ3, SEP 2 3 2003 ~~'; ;~~ MILLENNIUM SURGERY CENTER INC ` SitelD: 015-021-002213 Manager KATHLEEN ALLMAN Location: 9300 STOCKDALE HWY 200 City BAKERSFIELD CommCode: BFD STA 11 EPA Numb: BusPhone: (661) 663-3700 Map 123 CommHaz High Grid: 05A FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title KATHLEEN ALLMAN / ADMINISTRATOR MIKE BLACKFORD / FACILITY COORD Business Phone: (661) 663-3700x Business Phone: (661) 663-3700x 24-Hour Phone (661) 319-6999x 24-Hour Phone (661) 496-6626x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press Phone: State: Zip Contact MIKE BLACKFORD Phone: (661) 663-3700x MailAddr: 9300 STOCKDALE HWY 200 State: CA City BAKERSFIELD Zip 93311 Owner MILLENNIUM SURGERY CENTER INC Address 9300 STOCKDALE HWY 200 City BAKERSFIELD Period to Preparers Certif'd: ParcelNo: Emergency Directives: PROG A - HAZMAT PROG T - ABOVEGROUND STORAGE TANK ImmHlth DelHlth (661) 663-3700x CA 93311 TotalASTs: _ TotalUSTs: _ RSs: No ~~4 ENr~ ~~N 1 ~ ~DD7 i •.:, _ ~ f;. rats rn~: inquiry of those individuals :-;~..,,,;~;~;it~~;~; tf}r ot~t~inmg the information, 1 certify u,•ci~„r~er~~lty of law that I have personally r.~amined anct am familiar with the information ~.umitted and believe the information is true, aLcurate, and complete. _ ~~~~~~~ ~~ognature e Date Gal Gal -1- 05/22/2007 F MILLENNIUM SURGERY CENTER INC ~ Hazmat Inventory ~ MCP+DailyMax Order = SiteID: 015-021-002213 ~ By Facility Unit ~ Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE F P IH G 1696.00 FT3 Hi OXYGEN F IH DH G 3000.00 FT3 Low DIESEL L 65.00 GAL Low NITROGEN F P IH G 1332.00 FT3 Min -2- 05/22/2007 -3- 05/22/2007 F MILLENNIUM SURGERY CENTER INC SiteID: 015-021-002213 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME NITROUS OXIDE Days On Site 365 Location within this Facility Unit Map: Grid: TANK RM NW CRNR OF BLDG CAS# 10024-97-2 ~GaSATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE -TPure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum - I Daily Average 424.00 FT3 1696.00 FT3 1696.00 FT3 nti~t~rcl.~vu~ ~.vlnrviv~lvlJ -- %Wt. RS CAS# 100.00 Nitrous Oxide No 10024972 riAGL-1ttL HJ Jl"~JJ1~1~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0003 COMMON NAME / CHEMICAL NAME OXYGEN Location within this Facility Unit TANK RM NW CRNR OF BLDG STATE TYPE PRESSURE _ Gas TPure Above Ambient Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 7782-44-7 TEMPERATURE CONTAINER TYPE Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 249.00 FT3 3000.00 FT3 3000.00 FT3 nxc~r~l~vuJ ~vrirvtvlJty t J ~Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 I1HGtiKL tiJ JL~.7.71"1L~1V1~7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -4- 05/22/2007 ~. r ' F MILLENNIUM SURGERY CENTER INC SiteID: 015-021-002213 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME DIESEL Days On Site 365 Location within this Facility Unit Map: Grid: UNDER GENERATOR NW CRNR OF BLDG CAS# Liquid TMixtur~AmbRent~E ~ AmbientT~E ABOVEOGROIINDRTANKE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 65.00 GAL 65.00 GAL _ 65.00 GAL nt~~titcl~vu~ ~,vrlrvlvlJlvl~ __ oWt. RS CAS# 100.00 Diesel Fuel No. 2 No 68476302 t1HGKKL E'~J 5~~7~71~1I!ilV 1 7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Low ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME NITROGEN Days On Site 365 Location within this Facility Unit Map: Grid: TANK RM NW CRNR OF BLDG CAS# 7727-37-9 STATE T TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas 1 Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 222.00 FT3 1332.00 FT3 1332.00 FT3 lzsjc~rucLV~a l.Vllt'V1V~1V 1.7 %Wt. RS CAS# 100.00 Nitrogen No 7727379 -- lltiGtiRL FiJ JL~J.71"1L~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -5- 05/22/2007 •~ F MILLENNIUM SURGERY CENTER INC SiteID: 015-021-002213 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 02/02/2007 EMPLOYEES ARE NOTIFIED WITH ALL CALL ON TELEPHONE SYSTEM. EACH AREA OF THE SUITE CLEARS THEIR AREA OF EMPLOYEES, PATIENTS AND VISITORS. NEIGHBORING SUITES ARE NOTIFIED AS EMPLOYEES LEAVE THE BUILDING. THERE ARE NO NEIGHBORING BUILDINGS. THE SUITE IS MONITORED BY SECURE MONITORING CO 326-1747. Employee Notif./Evacuation 02/02/2007 EMPLOYEE ARE NOTIFIED WITH ALL CALL ON TELEPHONE SYSTEM. EACH AREA OF THE SUITE CLEARS THEIR AREA OF EMPLOYEES, PATIENTS AND VISITORS. NEIGHBORING SUITES ARE NOTIFIED AS EMPLOYEES LEAVE THE BUILDING. THERE ARE NO NEIGHBORING BUILDINGS. THE SUITE IS MONITORED BY SECURE MONITORING CO 326-1747. 9 9 Public Notif./Evacuation 02/02/2007 EMERGENCY GENERATOR - SEPARATE OUTSIDE BRICK ENCLOSURE. DIESEL GAS STORED ABOVE GROUND. VISUAL LEAK DETECTION PERFORMED, MONITORED, AND DOCUMENTED ON GENERATOR LOG MEDICAL GASES - STORAGE CLOSET OUTSIDE ACCESS NW CORNER OF BUILDING ALARM MONITOR VISUAL AND SOUND. Emergency Medical Plan 02/02/2007 MEDICAL EMERGENCIES ARE ADDRESSED IMMEDIATELY BY COMPLETING WORKERS COMP FORMS AND SENDING EMPLOYEES TO SOUTHWEST URGENT CARE, 6401 TRUXTUN AVE. IF INJURIES ARE SEVERE, EMPLOYEE WILL GO DIRECTLY TO MERCY SOUTHWEST HOSPITAL. -6- 05/22/2007 i+ F MILLENNIUM SURGERY CENTER INC SiteID: 015-021-002213 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 02/02/2007 ~ KATHLEEN ALLMAN, ADMINISTRATOR, IS RESPONSIBLE FOR NOTIFYING AUTHORITIES, AND ANY RELATED MATTERS. MICHAEL BLACKFORD IS SECOND IN COMMAND TO MAKE SURE THAT THE RESPONSILITIES ARE MET. ltclcaac L.V11 t.d 111111C11L - ~..1Cd11 V~J v 1.11C1 1CC -~VU1l.:C 1'il: l.lVdl.l Vil -7- 05/22/2007 S Jf .. .- ~~ F MILLENNIUM SURGERY CENTER INC SiteID: 015-021-002213 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .7~JCC;1d1 Ild'Gdl. U~ utility snut-otts Fire-Protec./Avail. Water = ~~ ~ ~~ tr' ~S~ Building Occupancy Level 12/27/2006 40 EMPLOYEES (v~I ~ mRl~r.~s -8- 05/22/2007 _ .. / .. } F MILLENNIUM SURGERY CENTER INC SiteID: 015-021-002213 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 06/26/2006 ~ MSDS SHEES ON FILE IN FRONT OFFICE WITH POLICY AND PROCEDURE MANUALS BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE SHOWN WHERE SHUT-OFF VALVES AND EXTINGUISHERS ARE LOCATED. THEY ARE INSTRUCTED WHAT TO DO IN CASE OF A FIRE AND PARTICIPATE IN FIRE DRILLS. ALL EMPLOYEES KNOW WHERE THE MSDS SHEETS ARE LOCATED. MOSTLY IN-SERVICE ADDRESSES SAFETY. THERE ARE QUARTERLY FIRE DRILLS. rayC ~ •ac.i.u ivt ru~.utc vac AC 1 ~.L 1 V 1 D u l.. U1 C V .~ C -9- 05/22/2007 YaU i ~iair 5~ u! j Cfff'd~lvas: •~ idl?;open ~ ~ ~;ilreus Oxide ;~. Orra~n 1 B ~ t ~ o t. ~ _...... 1 .' a _..~_ ~ ~ • _~ , e e a~ 6 9 E UI L~J ~` r~ ~ r ~ \ ~~ ~~C ~~~~ o d~1~A r ~4 CC r.~ ~e~^ mom m Att 9 1 o ~ ~~~ ~J~ ~,I 4 a ~ .~ ~~-- ~ ~~ --, --; 1 t g;~-~-i i C ~ ti ; i _.- t if %, ~ ~, ~. 1. i;~~= -.. i~ i liii ~~ e. " r 1~ ~i ~. ~. ~ _ _ e: 9 '.i P~~ ~~I Main Wafer Sh Off Valve i ,~ ~r ,i ~ ,t I t - Prevention Services - UNIFIED PROG-RAM INSPECTION CHECKLIST _~ B .~ t; R s F , 0 900 Truxtun Ave., Suite 210 FIRE Bakersfield, CA 93301 - SECTION 1: Business Plan and Inventory Program ~ "R'"' Tel.: (661)326-x979 Fax: (661) 872-2171 . FACILITY NAME - z ~2 ~ / l 2( = ~ INSPECTION DATE Gb ' 2~ ' ° INSPECTION TIME 0 ~ 1~ e~~f ~ ~r o . ! tot T j ADDRESS - ~ q3~ o~~-~,~~ PHONE NO. - ~~3-.37~ NO OF EMPLOYEES ~t~ FACILITY CONTACT BUSINESS ID NUMBER ~~ - 4 15-021- dt9ZZ/.,3 f -- 1 - -- - - - -j~- Section 1: Business Plan and inventory Program." ~ ~ ~" ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION "' C V ~ C=Compliance OPERATFON V=Violation - COMMENTS ^ APPROPRIATE PERMIT ON HAND r ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE -.. Y ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS li~ ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION D ^ PROPER SEGREGATION OF MATERIAL 7 ^ VERIFICATION OF MSDS AVAILABILITY rf,Y ^ VERIFICATION OF HAZ MAT TRAINING ~'C~ .^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES , ^` EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED 1~ ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUESTIONS REGARDING TIiIS INSPECTION? PLEASE CALL US AT (661) 326-3979 <E.1-.~ 'may,-~-So,~ ~3 t b I Inspector (Please Print) Fire Prevention / 1~~ In /Shift of Site/Station # Busi ess Site / n ' le Party (Please Print) White -Prevention Services - Yellow -Station Copy - Pink -Business Copy FD 2155 (Rev. 09/05 ^ YES. CIO - UNIFIED PROGRAM INSPECT~I®N CHECKLISTt T7~°.S'.?? »?-"~R t~.:xYk~,w., :_iu,..°.m;.~'e`k.9fz k3t:.t,: r .< .~.,...r ~.?2':. ~ ,. , .. , . . t .q'°... _ ..w :a:~ . , . ~ _ - r ~.,.. E. s< _ .... SECTION 1 o Business Plan and Inventory Program BAKERSFIELD FIRE DEPT Prevention Services ~~Ra 900 Tnixtun Ave., Suite 210 aaxrM t Bakersfield, CA 933(~c~ Tel.: (661) 326-3979 27?00 Fax: (661) 872-2171 s FACILITY NAME ~~ F ~. ,~ P~ ~L INSPECTION DATE I I~ t~ - INSPECTION TIME ~~ov P~ ZvM ADDRESS ~~ ~L ra- Zot~ HONE NO. 3 '~ 7 ~a O OF EMPLOYEES ~ o - q-© FACILITY CONTACT ~ USINESS ID NUMBER 15-021- ~z~-t3 I ~-~- '^~'fQ(L 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 ^ BUSlftf3SS 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 P OCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~ D e C ~ ^~ Inspector (PI se Print) Fire Preventio / 1°~ In /Shift of Site/Station # Business Site/School S e Responsible Party (Please Print) YES ^ NO ~°~ White -Prevention Services Yellow -Station Copy Pink -Business Copy FD2049 (Rav. 02/05) UNIFIED PROGRAM INSPECTION 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 --- ------------- ----L---- - -s---- -...- - -- --- - ADDRESS PHONE No. No. of Employees I FACILITYCONTACT ~( Business 1D Number fy//C/-~9E~ ~L.~l/~ FD/1,D OC` 15-021-002 I3 Section 1: Business Plan and Inventory Program l3'Routine ^ Combined O Joint Agency ^Mu1ti-Agency ^ Complaint ^ Re-inspection C V \V=VioatonnCel OPERATION ~^ APPROPRIATE PERMIT ON HAND COMMENTS L~J BUSINESS PLAN CONTACT INFORMATION ACCURATE - --- ---------- ------- ~-P aka c _Co_ Nit' ~iY~o--------------------- CCY ^ VISIBLE ADDRESS i~ ^ CORRECT OCCUPANCY C~' ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES (~ ^ VERIFICATION OF LOCATION l~ ^ PROPER SEGREGATION OF MATERIAL ~^ VERIFICATION OF MSDS AVAILABILITYE - - i~ ^ VERIFICATION OF HAT MAT TRAINING - - i~ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES EMERGENCY PROCEDURES ADEQUATE l~ ^ CONTAINERS PROPERLY LABELED ..-..- -- -- ---- Ld ^ HOUSEKEEPING ------- -------------- ----------- ^ FIRE PROTECTION - - L9 U SITE DIAGRAM ADEQUATE Br ON HAND ANY HAZARDOUS WASTE ON SITE: ~ES EXPLAIN: __ ~,~5 "~~~ W ^ No :/ %/ 111 m ~ ~ QUESTION EG ING THIS INSPECTIONS PLEASE CALL US AT ~GF)'I ~ 328-3979 -- Inspector----------._.._...-----~dge Ao.----- White -Environmental Services Yellow • Station Copy B siness Site Re on I rty Pink -Business Copy ) <} -- UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program ~~~) ~ C~\ ~ Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield. CA 93301 Tel: (66 ~)326-3979 INSPECTION DATE INSPECTION TIME -U_-ß?! ;3~~~ PHONE No, No, of Employees 6(G3_:32~ __512_._____ Business 10 Number 15-021- 0 () 2,:2. ~ FACILITY NAME fJ1 / t L IE A/I--.ll! U 1M -~J,l£ß-&j2. f/ (i._T'l5.,-+_.r__fl/ ~____ ADDRESS c¡ 00 SrOCK OA-L.E fi..l4/y" ~~oo FACILlTYCONTACT !'f11 C/-J4£ L8 /. It.,c S~ction1 : Business Plan~nd Inveritofy Program e-Routine, LJ Combined LJ Joint Agency LJ Multi-Agency LJ Complaint LJ Re-inspection c V ~LJ ( C=Compliance ) V=Violation OPERATION COMMENTS ApPROPRIATE PERMIT ON HAND --------------- --,---------_.,...._-----,-----,-----------------,--,--._-----------,-----,-,--,-,---- ~' ~ BUSINESS PLAN CONTACT INFO~~~~~~__.~~~':.~TE _________ __µL..1!:¡~____c..~..!i.t:l~L_.iK.ð2_____________u_______________ (?" LJ VISIBLE ADDRESS -,-------------------------------- --- -_.._--------------,--,----,-----------,----,-----,-----_......_,---------- 9"" LJ CORRECT OCCUPANCY -.------- ,_____,___ _____..______,____,_____,__ .______,_____,___,______________,__'_n__,_________.._.__ __,.._,__..__,__ 13'" LJ VERIFICATION OF INVENTORY MATERIALS - ...--------------..,--. .-----------.--.--.--.--..--..---.--------------------------.-.--..,.--- .---.--'--- ~'LJ VERIFICATION OF QUANTITIES _____,__________________,________,_____,_~_ __________,______________________.___________,__..__.._,_______,__u_,___,___.._,_,______ ~LJ B"'LJ 7"LJ VERIFICATION OF LOCATION .---- --------------_.._,--_._-------_._-~---_._.._._------'---'- PROPER SEGREGATION OF MATERIAL "---------.-----..----. ...._.-----_._------~-_...._--------------_._---_.__.---....--...--- VERIFICATION OF MSDS AVAILABILlTYE -----------------p-------...----.-.-- ----_.._.__._--_._----_.__._---~---_._._------------_._~-------- ¡;y" LJ VERIFICATION OF HAT MAT TRAINING __ _________,_____,_____ ________________,_______,______,_______,.._,_..._.______'n___ a-" LJ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~ EM~RGENCY PR~CEDUR~ ADEQ~ATE -,------.------ ------,-----------------------.---------------- -- ------------------------------..,-- --,---------_.._-,----------------_._-',---,-------------,-,,-- c;y LJ CONTAINERS PROPERLY LABELED -----p-----_.._-------_._----_.,.._~..__. -.--.-----------------..------.--.----.-....---.----------- ~ LJ HOUSEKEEPING ~ -----------------------,--,---------,- -------------,-----------,--------- ~ LJ FIRE PROTECTION ---r- ',--,--,-------- ~_____________,:......_..___________,__..__________'__m_______--,- rn" LJ SITE DIAGRAM ADEQUATE & ON HAND EXPLAIN: lIð.J 8/,ç- W#5tJ.c ~/ /LJ- CLLd....t&dL N m ø I § I ~- ~ ANY HAZARDOUS WASTE ON SITE?: ¡:yc{ ES LJ No ING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 -----fL~------ White . Environmental SelVices Yellow . Station Copy Pink . Business Copy ) (CJ ¿'" p... /'" ,'( MILLENNIUM SURGERY CE.R INC .KJ\--n+L.EEt0 ALl.-NA-N Manager : :M:"reIt~L"'Ae*"VQRD'- Location: 9300 STOCKDALE HWY 200 City '. BAKERSFIELD -- n-~--) SiteID: 015-021-002213 't~~~ St(,.~ ~,~ BusPhone: Map : 123 Grid: 05A (661) 663-3700 CommHaz : Moderate FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 11 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title KATHLEEN ALLMAN / ADINISTRATOR MIKE BLACKFORD / FACILITY COORD Business Phone: (661) 663-3700x Business Phone: (661) 663-3700x 24-Hour Phone : (661) 319-6999x 24-Hour Phone : (661) 496-6626x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth ~- - -- - -~---- Phone: (661) 663-3700x State: CA Zip : 93311 Phone: (661) 663-3700x State: CA Zip : 93311 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Contact : MailAddr: 9300 STOCKDALE HWY 200 City : BAKERSFIELD Owner Address City MILLENNIUM SURGERY CENTER INC : 9300 STOCKDALE HWY 200 : BAKERSFIELD Period : Preparer: Certif'd: ParcelNo: to Emergency Directives: - ~--. ~_____·'.:oo--.n_ O,K. A-lImGvf\ D h (Typsor prlntnam0) 0 eraby certify ~hat ~ haw~ r~v;ewSd the attached hazardous materiQ1ls manag¡g¡o menfþlan ior M'.::,e;- - - - --- ~-. - . --- - - , (Name ct, BuSIn0S1:1) and tha2 It along wi~h any corredions !C0f1S2ituts a comnls(,~ ~n"" Ii'" ''''' CQ!, iY oorrSd man- agem(98lí ¡glan ~ºr my 1~ci!it1f. -, - - ~~G!Q tUfGI ~ . { ~ '03 Date -1- 09/12/2003 ,,", Apr-08-03 02:32pm From-I, ¡ 118nni.uri8ry C8nter,lnc. 661 663 3737 . T-929 P,OOI!007 F-811 . ,. .-..- ----.- --......-. - ..- . .-..-- MILLENNIUM SURGERY CENTER1 INC., 9300· Stockdale H\Vy, Ste. 2ÖO Bolœrsfield. C~ 93311 tel 661-663-3700 · fOJ( 661-663-'3137 TO: 1; # of pages including covèr sheet 7 DATE: FROM: ~~) ~: PH~N;] ~~d--~\1 , FAX#, 10 @: Millennium Surgery Center. Inc. THIS MESSAGE IS CONFIDENTIAl AND IS ONlY,INTENDEÞ FOR THE USE OF THE INDIVIDUAL OR ENTITY ADDRESSED. II+' '.~ ~. 1 <»m rc.e¡ u.es-h~ 0-... I r ~~~y;) ) Qf ~v\ \'11 ~r rvvrì I \ Ç- -th\~ is u-l Ý\AÅ ~ I ¡~î ~\ -' Å~,). \r~J I ¡ 80... -}- '1 -+- \ . CG '0- Ÿ\. ~~Q~ LR'lD~. -~lDD. From-Uillenn~UrlerY Center,ine. 661 669 9797 . T-929 P.002/007 F-811 Apr-08-0S -' CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (66() 326-3979 HAZARDOUSMATE~S~AGEMENTPLAN INST 1. ~avoid further action, return this fonn within 30 days ofreceipr. 2. YPE/PRlNT ANSWERS IN ENGLISH. 3. we:r the questions below for the business as a whole. , 4. Be as brief and concise as possible. 5. iou may also attach Business Owner I Operator Form and Chemical Description Fonn(s) t1 the £rant of this plan instead of completing SECTION I. below for initial submission. SEC110ï I: BUSINESS IDENTIFICA TIQN DATA BUSINE,S NAME: MILLE:ImIUM SURGERY CENTER) INC. LOCATIfN: 9300 STOCKDALE HWY.. SUITE 200 MAlLINC!i ADDRESS: 9300 STOCKDALE HWY.. SUITE 200 I CITY= -!~AKF.R.SFTF.T,T'I STATE~ CA ZIP;93311 ." PRONE= 661-663-3700 PRll\.1AR ACfNITY: mJ'i'-'PA'T'TF.NT ~JœOE~ ~E~IJ"E'\i OWNER: MILLENNIUM: SURGERY C~TER: INC. P!l()~: 661-293-3700' 9300 STOCKDALE BWY.. SUIt~ 209, BAKERSF.IELD. CA 23311 EMERGE CY NOTIFICATION I COfTACT 1. KATHLEJ¡:N ALLMAN 2. MIKE BJACKFORD I TITLE BUS. PHONE 24 HR.. PHONE ADMINISTRATOR (661) 663-3700 '319-6999 FACILITY COORDINATOR (6611663-3700 496-6626 1 Apr-08-0S O%:SSpm From-Ui Ilenni.UrierV Center,lnç. 861 883 3T3T . T-9%9 P,003/00T F-811 RAZARDOUSMATE~S~~NAGEMENTPLAN N re. {: DISCOVERY Am> N A. LEAK DETECTION AND MONITORlNG PROCEDURES: GENCY GENERATOR - Separate outside- brick enclosure. D~esel gas stored above ground. Visual leak detec~ion performed. MOnitored and documented on Generator Log. MED GAL GASES - sto~~ge closet- outside áccess NY corner of building. A1årm mon1tor- v~sual and sound. B. LOYEE AND AGENCY NOTIFICATION: Empl ees are notified ~th ALL CALL on telephone system. Each area of the suite their area of employees, patients and·v~sitors. Neighboring ~uites are notifie. as em loyees leave the building. There are no neighboring buildings. The suite is monit red by SECURE. (661)326-1747. Monitoring Company toll £re~ number is (800)458-4! " C. ~ONMENTAL RESPONSE MANAGEMENT: Kath1ee¡ A1l~n, Adœin1strator is responsible for notifying author~t1es, and any related matters. Michael Blackford is second in command to iliake sure that the r~spons- ·l·t· I t ~ ~ ~es re me . "!. D. GENCY MEDICAL PLAN: . Mœdical ,me~g~nCieS are addressed immedia~ely by forms an1 s~nding employeesf to Sou~hwes~ Urgent COC 93311 If inju~ies a~a severe. employees will completing Worker's Compensation Caré, 6401 Truxtun Ave.. Bakersfield. go d~rec~ly to Me~cy Southwest Hospital. 2 Apr-08-03 02:33pm From-loti Ilenn.ursery Center, Inc. 661 663 313T . T-929 P,004/001 F-811 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 BUSINESS OWNER I OPERATOR IDENTIFICATION. FACILITY INFORMATION "'age _ 01 _ ---- ~~CIUTY ID # 1--1 I Year Eleginning BUS [NESS NAME (sa 0 ò!IIi FAC1U1Y NAME 01 DBA- COi~ Bumea& As) Millennium'S rgery Center. INC. -. SITE A~~RE;SS I 9300 Stockdale Hwy.. Suite 200 ::. .a~r.u.~. ,~: : ¡ :::-- BRADSTREeT N4A " (4 Digit#) . COUNlY IŒIUL~L~~ ._____. ____ 1011 OPE:RATOR NAME 108 'OPERATOR ÞHONE 110 ': '!~~;:!:: : '";;~,,,~:,)(\;:~,:,~ /':.5:;: :'f.~.~j''':,~~'.. :1;;·~~i¡;.;~~~"~~1~~r-~~tf-,:;;¿:..:.i ¡;',¡., ;.(Í.~.J ,'<;.\" r,';"'(r"~""::~~"::'~':"-:"-G 11'~,. ,~... .:':. :/~:'~~?':;' . t,:>~,r",'q'':; :\::~.:: ,..,~. . ;-::, ;:.. ,~: ,~~., : ,~, j. ..;'=.:.... ;"'< " '.~ I": '!r("·t:'~ ..,.:.:,,- .~~;',-,":.¡'.,:o '::"'~-';'!~"~I.:U!:f:eWNER,INFORMÆ.....ON: :..~...:.,;¡¡:; .... .. .:..,..,'..,, " "'.:., J', :,., ,'...;. ".' '.~ ..'.,..,.. ...~.~!t .' . ..' .' ,I, "":",, .., ... .. ~...., ,~, ,t»..\:. .....':"\:.., ,¡J............. r,.~}.'·.....r~ ,r ..,ro: .....:..;\.. \.,'''''''" r'''''::''.I.~ ". ..... .. ...'2'..,. .,' " ..,'..... .. ,,'" ." .,', . . ': ../:t:. ... .:; l ~ACIUTY 1[)'ENTl~~CATIÐN 100 : Year I!ndlng I I 3 I BUSINESg-pfjONE 661-663-3700 IC to: ]03 ...-,.-- 105 tOt OWNER NAME QWNER MAII.ING 93 ADDRESS 111 OWNERPHONË 661-663-3700 112 113 CITY B 11$ .CONTACTNMtE KAt""" ATT~AN CONTACT MAILING 9 00 STOCKDALE HWY SUITE 200 ADDRESS .. ¡;n1_1í1í"ol_~7nn 11e 119 CITY 1a-t ZIP 93311 122 . .......... _t.. \'''':~ ..... ", I'r'....., ~:i:.;j'" A..~· ·"i..il·'~I· ,.... ~.;¡....u:·.;:.'·~,,·:-:.&.. .!'~~. ....,I'iI'..:..-:..:~!tI-...::..~:2~~r.: . \. !t'.~,;, . ....:.f; ~ 10r0:~1\'~ ·I"'~.:-:;" ~. . ~"ö', :-.:.,.f '...:. ," .. "~':I ··~.:,v-..· ";'1 ., ~ -,:~ !.,- ¡¡;.'.) 'j.~': :\¡.,. . MAil" .;¡,,,,,~>':....,,;, ',:' ":~~'~'~'~·:;/'··IV~'ii:EMERGI:·tJcYJ'\:'¿. 'N':t; (itdT.·~:'·?rii.-':·>?;';~.-:t:,~~·.I7;!''''·~'''l:ØNbÁRy.'' '! '." .,',:.::..;..\..;,': '::';'~:.:~I·::-:": ·'.'.;~:l" ': .q·:·.r··..I:··1 þ o " ·f':'~iIo~.1.7~:;·r'. t·,:::ð.. \...~.~;;::~.. ·':·~;Jr~ ~ "~I-;._' 'INt:"';';-· ~~-.: ;II'~,.'.!_...:' L~ ~... ..~~to'{~: ";'I·..t·~~:. ~tf~ .::'¡;. .?...";¡,,:.....~.,.... t "" . I, . ~. .... ~., .: .: .:~'::- " , :- NAME KATHLEEN J.LMAN 123 NAMa 1211 !iíL.E .ADMINISTRA.iOR 125 TITLE 130 BUSINe:SS PHONE 6 1-663-3700 126 111 24·HQUR PHONE 6 1-319-6999 tV 24-HOUR PHONE 13a PAGER # NO!fE 128 I PAGER# NONE 1~ ...~:~U'::~I;~{'.~,~~',.,::·., '. ~.::,',: ;::':>;·;:·;:~::f2Y;D~~~T,F.IC~ijÇ~r-<:.': ..!d::~;,(,;,'.:jè~:ji:· "'~'.,.:>'<, . >.,~~ ¡ :ertlfication: eased on m Inquiry of those Individuals responsible for obtaining the Infolmation. I certify under penally of law that \ have persor¡ally examined ~ndam familiar with the Information liIubmittsd In this inventory ang believe the intbnnatian it¡ true. accurata. and QQII1plete. 3 GNATURE! OF OWNe PERATOR /. DATe 114 NAM OF OëUMENT p~~~ 135 ~ ~~" ~\L~ '''t:=EAA5P~TOR - ,» .---..-........ ~CF (7/99) S;\CUPAFORMS\OES2730.TV4.wpd Apr-08-03 02:33pm From-lAillenn.uraery Center,lnc. 861 883 3131 . T-929 P,005/001 F-811 HAZARDOUS MATERIALS MANAGEMENT PLAN Section 111.1 ¥ FACIUTY AND LOCALITY INFORMATION I t I LOCATION OF S¡., UT-OFFS AT YOUR FACILITY: I UTILITY SHUT -OFFS Millennium S~rgery Center~ Inc. NATURAL GAS I F ROPANE: North side of the building NW corner ELECTRICAL: llnside North door en~ranc:e. left side of hall, and i1IlIIlediate left inside Supply R. East 5~de of building, outside WATER: I LOCK BOX: YES l NO I I I A. PRIVATE FIRE PROTeCTION: SPECIAL: IF YES, LOCATION: Outside :front entrance of bu1ld1n~ PRIVATi: FIRE PROTECnON J WATeRAV~LABIUTY 8. WATER AVAlTILITY (FIRE HYORANT): I TRAINING A. 8. NUMBER OF E PLOYEES: 40 MATERIAlSD TASHEETSONFILE: in front office with Policy and Procedure Manuals I BRIEF $UM~Y OF TRAINING PROGRAM: Employees arcl shown where sh~t off valves and extinguishers are loca~ed. They are instructed .. ~. what to do iD case of a fire and participate iu fire drills.' All eœployees know where the MSDS sheets B re locatd. Mostly inservices address safety. There ae quarterly Fire drills. CERTIFICATION 1Sa<! "" my inquiry ollhasco JnI NI\ 11'13 ~8Ib1e lot oÞ1aIn1n¡¡ Iho In/QomallOn. 1 ceIIify \II1ger penally 01 laW 1/1811_8 ~ ~ and II1II EatniIi;Ir wIIh lI1ølntørmalllln subMiIIc4 eng ÞeIIeva 111. ~UQI1I& 1Mt. 8cc:1118t8. and _ 1p1lllll. ~¡~ DATE .qT. 12/12/02 "..- IME: OF SIGNeR (pIIU) I 47a. TITLE OP SlGNÈR 47Ø, _,_..~~.:~een At1man Administra.tor =(7JØ1 s.'\PROCSDURS M/IN\.IALINeW HMMP form.wød . . NW N 'w -+- E 5 + I GAS .¿, S~t:"T Of¡=: It' o ~ 0( -'a: w w (j) 2: III W ë:t!J -' '< ( Q w c ( 11.' < ~ r!- WATER I SHUT OFF SURGERY SITE D'AGRAM PLAN -í >- 'D ... I c:> CD I c:> <0> c:> ~ , .. <0> <0> 'D EI -n ... c a I s:: œ :::J :::J _. s::: 51 en s::: ;¡ œ ... ... n œ :::J - œ ... - :::J n CD CD CD CD <0> <0> .... <0> .... -t I CD ~ CD "U c:> c:> CD ~ c:> .... -n I CD Apr-08-03 02:34pm FrDm-Ui Ilenni~UrierY Center,lnc. 881 883 31ST . T-929 P,OOT/OOT F-811 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKI..IST 1115 Chester Ave., 3ht Floor, Bakersfield, CA 9,3301 /n, II ¡:.> ,'1.' / / I,':!. ,'¡' .' t FACILITY AME ~", .,- t. .-"-.,." v~ ' . ",; . .¡ r ADDRESS ï~' ~:'U ~<..J", ,,/j (-4 ~ - _"'it:? ,;0 FACILITY C NTACf ¿:::.,¡ ,,(,1'1 /'("r",v . ,/ ¡¡,,.~,~"'-,' INSPECTIO TIME ~l .. INSPECTION DATE ¡ {, ,? (. ë~ PHONE NO. (,. (, '.; - 7:-:¡r--rl ~~~~~iS ~~ ~~PL¿'~~O ~~'J z, , - , //', L Z I ~ Section J; ~Routine Business Plan aDd Inventury Program o Combined o Joint Agency o Mu!tí.Agency a Complaint ORe-inspection OPERATION c V COMMENTS Appropriarc pc . it on hand Business pllUJ ~nt1ict infonnation ~te 'Visible address I Correct occupanþy Verification ofiuvcntoty materials I Verft1cadon of qþnUties Verification on ation - ... Proper segregati n of material Verification of~SDS availability Verification of H~ Mal tl1lining Verification ofab, tement supplies and proccdurei E;nergelicy proc~ures ~uate Containers pro y labeled v' ./ Housekeepin,g Fi~ Protection ,~ Site Diagram Ade uate &. On Hand C-CompJ;",ce r=Violadon . Any høardous raste on site?: Expllljn: Qoesdon. --1.... -, PI.... <011 us at (661) 326-3919 . Wbl" - E'l "'~ YoII_ . ,...... c,p, ,,'" . ........ c.,., v' !:IVes ~ Business Site R.esponsible Party Inspector. . . . '. - To; ceo . .ge 1 of 1 2;53;00 PM. 4/8103 000000 - MR. FREDRICK MENDE. ABSA BANK OF SOUTH AFRICA, 9m FLOOR, HEERENGRACHT TOWER, e e CITY OF BAKERSFIEl..D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAl.. SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd I~'loor, Bakersfield, CA 9330) 1M i ll-f~1V ¡ U""" /I /_ FACILITY NAME SlA1!!Iï. Ct!'.v 1Ief7. ADDRESS 9 J fJú t:I.4 $ z...oo FACILITY CONTACT 1~~/IJ'Y1AW' INSPECTION TIME ',~O INSPECTION DATE I~ - IZ-O~ PHONE NO. (P(P") -: 3:¡cXJ BUSINESS ID NO. 15 JlO~Ç-OZ,( -Ol:Yz..z: I ~ NUMBER OF EMPLOYEES ð . Section i: " Routine Blj sñl!lles§ Plan and Inventory Program o Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V ,- COMMENTS App~opriate permit on hand .¡ Business plan contact information accurate .¡ 1+Je.Pf!JQ. /A í) ~'V\.A , I U Visible address Correct occupancy ¡ / Verification of inventory materials vi Verification of quantities v' Verification of location ",V Proper segregation of material J Verification of MSDS availability / Verification of Haz Mat training 1..1 Verification of abatement supplies and procedures ,./ r-J fN Emergency procedures adequate ./ 1/ Containers properly labeled .¡ Housekeeping v' Fire Protection 1/ V Site Diagram Adequate & On Hand Iv C=Compliance V=Violation Any IllUllzardm!ls wms~e on sate?: Explain: CJ Yes ~ While - Env. Svcs, Yellow· Station Copy Pink - Business Copy Inspecto . Questions regarding this inspection? Please call us at (661) 326-3979 Michael Blackford ÌIr! a'terials '~~'enl('nt, " ,FacjJjty·-.:ìjnator i ì . ¡ I 93~ktnckdale rEghway 11_" "0 : Ui,t: 200 / ¡BàkerstJdd, CJ\ 9,1311 ,. I ((,ORfð~/èiW_fi'.¡ç,ßO'ii'·¡ç7i»/-nl\lfi'o/; ~./',// Te] 66] 6633700 ,J)~bHnbH ~¡ç'UU[!;bú U!U~ Fax6616633707 . / Œ!LLENNWM .... -' '~~"~" sA- (~ 5:::6<::;(" /'"' ) r;'Á . ~~' , , r y.; ~\~K /, , . CITY OF BAKERSFIEI"D FIRE DEP AR:r~ENT (t\\~" y OFFICE OF ENVIRONMENTAL SERVICES '_ '\,/\11" /~/ // UNIFIED PROGRAM INSPECTION CHECKLIST "y 1715 Chester Ave., 3rd F'loor, Bakersfield, CA 9330]'~ ~ " -- , l ::i~) 3 INSPEÇTION DATE '( I; ! 61 PHONÉ NO. ~ '3 - ?"1o-ð BUSINESS ID NO. 15-21 0- ....,r;~ NUMBER OF EMPLOYEES -')Z> " ----.. FACILITY NAME JV1 f l(...,C....vN'~ ~~ ADDRESS er'300 S'TZ)C::~ 4F-z.c;o FACILITY CONTACT /l.1..t¡¿E ~~ ' INSPECTION TIME Section 1: t2lRoutine Business Plan and Inventory Program ' . D Combined D Joint Agency D Multi-Agency D Complaint D Re-inspection OPERA TION C V /' COMMENTS ........... Appropriate pennit on hand J / ,J'Gr.J D~t."I' Sl1'C '\ Business plan contact infonnation accurate I PLC--orSt? ~u::rr: ~ Visible address ~~ «~I C) f~ 1\.1. A.- ¡ L.- / : \., ,'. - - / Correct occupancy ,.. Veri fication of inventory materials Cft>1k/N'60 ~ (1\PiR i Verification of quantities lÅ Verification of location I{ Proper segregation of material Verification of MSDS availability - Verification of Haz Mat training VC~ ~ Or! ~ .- - -e.e : µt<2~ ~~I~ C..)f..... "'" ,. Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping .. Fire Protection Site Diagram Adequate & On Hand '(Le>&6 ~G19 ~/?82M/1 A.(i=t~ C=Compliance V=Violation ~~ Any hazardous waste on site?: Explain: DYes ~o M~  Business Site Responsible Party Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: W,^,'CS .. CITY OF BAKERSFIELa OmCE OF ENVIRONMENTAL SlkVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION NEW DADO D O£LETE D REVISE 200 (one tom! per ma/eti8/ per buldlng or area) Page 01 . :':~ ·'~-·:~~:~t~~:::/,~,~~~~~~~· :-"., ., .. 3 tJ <....J CflNCL 0{: 201i D Yes D No 202 204 CHEMICAL LOCATION CHEMICAL NAME ¡Jf'~&c~ . ",': ·~.~~~~:#~¡~r ¡ TRADE SECRET D Yes D No 206 If Subject to EPCRA. refer 10 instructions 207 Dves DNo 208 ; COMMON NAME CAS' 209 FIRE CODE HAZARD ClASSE 210 ' TYPE RE o m MlXTURÈ o w WASTE 211 RADIOACTIVE oVes DNo 212 CURIES 213 PHYSICAL STATE o I SOUD 0 I LIQUID ~S 214 LARGEST CONTAINER 6"? LID L) ~ '2 'Ä 2. c· r. ~SSURE RELEASE 04 ACUTE HEALTH 05 CHRONIC HEALTH 215 I FED HAZARD CATEGORIES I (Check all that apply) ANNUAL WASTE AMOUNT o 1 FIRE 0 2 REACTIVE 217 AVERAGE DAILV AMOUNT 13')'- 219 STATE WASTE CODE 236 [ 220j ! UNITS" o Ib L8S o In TONS 221 DAVS ON SITE 222¡ I STORAGE CONTAINER (Chock all lllal apply) I I I ¡ I o a ABOVEGROUND TANK Db UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEa DRUM De PlASTlCINONMETALLIC DRUM 01 CAN o 9 CARBOV o h SILO o I FIBER DRUM OJ BAG Ok BOX ~ CYUNDER o m GlASS BOTTlE o n PlASTIC BOTTLE 00 TOTE BIN o p TANK WAGON o q RAIL CAR o r OTHER 223 STORAGE PRESSURE o . AMBIENT ~ 'ABOVE AMBIENT o be BELOW AMBIENT 224 STORAGE TEMPERATURE ~MBIENT o .. ABOVE AMBIENT o be BaOW AMBIENT o c CRVOGENIC 225 226 I 2 230 ì I 3 234 I I 4 238 I 5 242 I 227 Dves 0 No 226 231 o Ves 0 No 232 235 oVesoNo 236 239 Dves DNo 240 243 Dves oNo 244 229 233 237 241 245 UPCF (7/99) S:\CUPAFORMS\OeS2731.TV4.wpd .. CITY OF BAKERSFIEL" OFl'ltE OF ENVIRONMENTAL SB.VICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION W DADO 200 D DELETE D REVISE BUSINESS NAME ( IV(. (L<.. 0J^" J'--... (one fonn per mllterlal per building or IIIDS) Page 01 .' '" 2011 OW WASTE 211 RADIOACTIVE 0 Ves 0 No .tš..GAS 214 lARGEST CONTAINER ''2.110 L) - ~, PRESSURE RElEASE 04 ACI1TE HEALTH 05 CHRONIC HEALTH (6<:76 218 ~UNT 1(;,~6 219 STATE WASTE CODE CHEMICAL LOCATION . 'e: I 'V "I ~ é" TMIC- R.1v\ FACILITY 10 of=- ßL.~ 203 ,~~'r~ ~,~€§~~~Ê~;~~~:J~.~\':' CHEMICAL NAME ,J 7T(WLJ5 O)L Ií)B 207 COMMON NAt.E CAS" 209 FIRE CODE HAZARD CLASS TYPE o m MIXTURE PHVSICAL STATE o s SOUD 0 I LIQUID FED HAZARD CATEGORIES (Check all that apply) ANNUAL WASTE AMOUNT o 1 FIRE 02 REACTIVE 217 o Ib LBS o b1 TONS UNITS' STORAGE CONTAINER (Check aU thaI apply) o a ABOVEGROUND TANK Db UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEel DRUM o e PlASTICINONMETALLIC DRUM Of CAN o 9 CARBOV o h SILO 01 ABER DRUM OJ BAG Ok BOX ~NDER Om GLASS BOmE o n PlASTIC BOTTLE 00 TOTE BIN o p TANK WAGON STORAGE PRESSURE ~ 'ABOVE AMBIENT o ba BELOW AMBIENT o . AMBIEI'lI' STORAGE TEMPERATURE ~AMBIENT o .. ABOVE AMBIENT o ba BelOW AMBIEI'lI' o Ves 0 No 202 204 ''" o Ves 0 No 206 If Subject to EPCRA. refer to instn.odlons 210 CURIES 213 c..c. 215 ~8 220 221 DAVS ON SITE 222 o q RAIL CAR Or OTHER 223 224 o c CRVOGENIC 225 ~§~~.~t\~·· :,.~~ r, <.::. :~;: =: ::,::<:~~~::;~~~.."/ ~~:~:r~~~:~::Å~"\:;:¡~~~'¡- .:' ';'~'\. .:/ :" ..< r ..:':~ ~~, ",... ~\ f1~ . '(:~ .~!; '<:.~:/::; ~~ J"t<;, , ~s. ~.~~< < :~4' '):~~.v -~~3çt~~~~j~;:~\\1~~~~r!f~~: ~~?~~~:~~:~~JI·~i ',:' "'''Ì>'~ ~.I ' .'" !. ., ,. ""d''':,';, .J. . "J . ,,1.1':..1 .{?,,),? ~''''C" ¡, ,,[;T.'!(,j3¡, 1\ " ',.,: ',':.; '~""';; . . ,:",,'., è' . ,,;.! II,; ...~-.;5"ct).. )';, Yn", "';~"""'''\''t.[!:..-.'.:4.*:, ¡-..'iN" ¡ .' ': . . _ ~_':-'.~., :,.........?....!'_~.a:.:.I·..:;~~:...j: J:·.:.....~.M~....:..~:.." .... ~. ~_., '. ~ "..'__~.:..._':...:.o...tt:.:..:·"¡,,.ti¡,¡.:;.....:-:..._..\·~ .».r ..ki'-....4~' lit.' ~-.;.._;.) .£!:....1I.~~-..:~.:;.f~~~..t........~~.;.IoÞ'...:...·......_. 226 227 Dves 0 No 228 229 I 2 230 231 o Ves 0 No 232 233 I 3 234 235 OVesONo 236 237 I I 4 238 239 OVes ONo 240 241 I 5 242 243 OVes ONo 244 245 I UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd .. CITY OF BAKERSFIEL. OFPrCE OF ENVIRONMENTAL S~VICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION W DADD 200 D DELeTE D REVISE . ~,1,~V:~:I~~~r,,~:~:~~~...~:'.~~tt:~.'..if~;·:::-~!:,j;~~,·:~,~~':' .... ': " Clt.ITYi 1"F.ØRMATION,;,",:':i~:::$'; '" -..' ¿",' (one rom! per me/fJ1ie1 per buidlng or a/fla) Page of .. CHEMICAL LOCATION 2011 3 . INS'D6 ÞF DLO~ FACILITY 10 II 203 o Ves 0 No 202 204 '", CHEMICAL NAME ~Y6-c-J 20S .¡ TRADE SECRET 0 Ves 0 No 206 If Sub ecllO EPCRA. ref.. to insllUctions 207 I COMMON NAME CAS II 209 FIRE CODE HAZARD TYPE o m MIXTURE o w WASTE 211 RADIOACTIVE oVes DNa RE PHVSICAL STATE ~GAS 214 LARGEST CONTAINER o s saUD o I LIQUID FED HAZARD CATEGORIES (Check aD that apply) ANNUAl WASTE AMOUNT ~SSURE RELEASE D 4 ACUTE HEALTH 218 AVERAGE CAlL V AMOUNT D 5 CHRONIC HEAlTH o 1 FIRE D 2 REACTIVE MAXIt.lJM ~ _1"""1 DAILY AMOUNT /~ D ga GAl ~CUFT . It EHS. amount must be In Ibs. 217 ::?ðOÒ D Ib LBS D b1 TONS 223 UNITS· STORAGE CONTAINER (C/leck an thaI apply) o a ABOVEGROUND TANK Db UNDERGROUND TANK D ç TANK INSIDE BUILDING D d STEEL DRUM De PlASTlCINONMETAlLIC DRUM DlCAN D 9 CARBOY D h SILO STORAGE PRESSURE ~VEAMBIENT o I FIBER DRUM OJ BAG D k BOX ~INDER D be BELOW AMBIENT o m GLASS BOTTLE o n PlASTIC BOTTLE D 0 TOTE BIN op TANK WAGON D . AMBIENT STORAGE TEMPERAT\JRE ¡a'-rAM8IENT D .. ABOVE AMBIENT D be BElOW AMBIENT 210 212 CURIES I 213 215 2~6 219 STATE WASTE CODE 220 221 DAVSONS/TE 222 o q RAIL CAR Dr OTHER 224 D ç CRVOGENIC 225 ! 2 230 231 D Ves 0 No 232 , i I 234 235 237 I 3 oVesoNo 236 I I 4 238 239 Dves oNo 240 241 I 5 242 243 oVes DNo 244 245 I ,UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd I CITY OF BAKERSFIELa OF CE OF ENVIRONMENTAL s'm{VICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION DADO 200 o DELETE o REVISE .' " .'.' ." BUSINESS NAME ( V'1, { (... L C.AlJN1U1-"'\- (one to"" per malerill' per buidlng Øt' a...a) Page aI .' CHEMICAL LOCATION 201/ 3 NW u,.rOC-4- Gr6~TC¥t Cfl.N(L FACILITY 10 D Yes D No 202 204 .." , CHEMICAL NAME 'VtEsGL- ' 205 TRADE SECRET D Yes D No 206 If Subjeà 10 EPCRA. ref« 10 instruclfons COMMON NAr.E EHS' Dves DNa 208 207 CAS. 209 FIRE CODE HAZAR[) ClA 210 : ~PURE D m MlXTURË D w WASTE 211 RADIOACTIVE Dyes DNa 212 I CURIES D s SOUD ø;..uaUID DgGAS 214 lARGEST CONTAINER (¿s;- ~RE D 2 REACTIVE D 3 PRESSURE RELEASE D 4 ACUTE HEALTH D 5 CHRONIC HEAlTH TYPE PHVSICAL STATE FED HAZARD CATEGORIES (Check all that apply) ANNUAL WASTE AMOUNT ! STORAGE CONTAINER I (Check aU that apply) I I 1 1 I 217 I MAXIMUM /' - DAlLV AMOUNT . b S UNITS· ßf oa GAL D d CU FT /--=if ENS. amount must be In Ibs. ~VEGROUND TANK De PlASTlCINONMETALLIC DRUM Db UNDERGROUND TANK D, CAN D ç TANK INSIDE BUILDING D 9 CARBOV D d STEEL DRUM D h SILO D m GLASS BOTTLE o n PlASTIC BOTTLE 00 TOTE BIN Dp TANK WAGON 218 I AVERAGE DAIL V AMOUNT D Ib LBS D In TONS 6 5' 219 o I FIBER DRUM OJ BAG Ok BOX o I CYLINDER STORAGEPRESSURf ~,AM8IENT ~IENT D 88 . ABOVE AMBIENT o be BELOW AMBIENT STORAGE TEMPERATURE D .. ABOVE AMBIENT o be BELOW AMBIENT D ç CRYOGENIC 225 213 215 ~8 ! STATE WASTE CODE 2201 ! 221 DAVS ON SITE 2221 D q RAIL CAR Or OrnER 223 224 ~~~,-,~~{~c~'~~~-~Xf\' ::~~·~:~~;::';,í::'::..:::,~"",'J~·;:i,;·,:\;;~ '.~. :. ,".. i. ~..::.; t~~I~':~/.;~'I{-'~~ ~dl~:,,._~, '~j; <) ~t\-:-:~/:\..}. '.~<~:,~?::;,~:.~~;:~~J:~:_=~"~{~:;:1fM;~~·~;X~t~~~~~pr§iÊi:·~S~~~~,f~;;\~~I~ ,.<;'" ~ ul.,( ,~! . .~. '>. ~·C·, ',., 'tV . "\~ ' j.}. f! /,,'t-..(..:,.t~'G^I),-ðF: .~,C...f.lI\.t[;tD\~~"'" I' ....".;. '. ". . , ( ~ ~ ., ¡I, 1 II,.,~ ~,,,>!~. ~t.-'::µ~èI.. 't ,'. ¡~"'''''.í*''.t;f~!~.u~1 l~:.1"h' I '. '" :\ :/"'..w.u: 1':":"~_'!-:":""" :;....r...1~'~ I··.:i;~"'.::·~ .zl'.:..~_.'¡~...: :'. '~~'. ,«.:'. .:, :.---: ~~:';, "/... <" .&ììt~·.. _.....;.\.:.:<.:.;;·Ji\.:.~;,\~ ;;¡._'J':..,·#k{.......~·!..I~;:; ~~:.:~~..~~~.:.:.....~~~.J.,<-,...t1·.~..*·· 228 227 Dves DNa 228 229 I 2 230 231 D Yes D No 232 233 ì I 3 234 235 o Ves 0 Na 238 237 I 4 238 239 Dves DNo 240 241 I 5 242 243 Dves DNo 244 245 I 'UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd