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HomeMy WebLinkAboutBUSINESS PLAN 3/26/2007i' ~~~~ _i ~~ ~x ii FOOT & ANKLE INSTITUTE __ ii 9300 STOCKDALE HWY ~~~~ ~~' ~ Prevention Services UNIFY GROGRAM INSPECTION CHECKLIST B E R s F t o 9ooTruxtunAve., suite 210 Fine . Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program "RTM r Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME INSPECTION DATE INSPECTION TIME voT ~'. Po~v k.4G ~r+s ~ i 1 N.T~ .~IZ~IO ADDRESS PHgN N O. NO OF EMPLOYEES ~`, - ! ~ ~O .S'~D G dL ~G ~ ~ W ~ } _ ~~ 44LL77 FACILITY CONTACT BUSINESS ID NUMBER 15-021-0 l $~O~ I ^ 06 Section 1: Susiness Plan at>Id~ I~venfory Program ^ ROUTINE ~jCOMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIn2SS 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 AR ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ~~ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND _~ ANY HAZARDOUS WASTE ON SITE? ~'S~ES ^ NO EXPLAIN: ~ ~~~~ r~: ~Xe r nnr-uuia 9~~ ~ QUE,S~TIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (667) 326 9 'I Inspector (Please Print) Fire Prevention / 1s' In /Shift of Site/Station # siness Site I Respon ible Party lease Print) ~ White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 ;~ ,.. ~~ `~~~`- -'r~"~ CITY OF BAKERSFIELD FIRE DEPARTMENT ~~ d ~c,~Vd FACILITY NAME ~OOT ~: /-~ /~ ~` ~ ~ n-Str T'~ i~ INSPECTION DATE 3 1 ~' I© Section 4: Hazardous Waste Generator Program EPA ID # ~'~°'`? r ^ Routine ~ Combined ^ Joint Agency ^Multf-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number ~;~C~:-.~. {~-- Authorized for waste treatment and/or storage Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line /V Secondary containment provided Conducts daily inspection of tanks Used oil. not contaminated with other hazardous waste /-~~~ Proper management of lead acid batteries including labels jv Proper management of used oil filters ~/ Transports hazardous waste with completed manifest Sends manifest copies to DISC Retains manifests for 3 years Retains hazardous waste analysis for 3 years .E'~~ /1/U Retains copies of used oil receipts for 3 years > Determines if waste is restricted from land disposal ~=~ompt~ance v=vtotanon Inspector: ~ ~G ~~~ ~j ~- ~ Office of Environmental Services (661) 326-3979 White -Env. Svcs. b OFFICE OF ENVIRONMENTAL SERVICES •y UNIFIED PROGRAM INSPECTION CHECKLIST ate '~ ti 1715 Chester Ave., 3~d Floor, Bakersfield, CA 93301 ~.~ B e Site R p Bible Party Pink -Business Cop F FOOT & ANKLE INSTITUTE SiteTD: 015-021-002082 Manager LINDA GREESON Location: 9300 STOCKDALE HWY City : BAKERSFIELD BusPhone: (661) 663-8483 Map 102 CommHaz Minimal Grid: 32 FacUnits: 1 AOV: CommCode: BFD STA 11 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title LINDA GREESON / MANAGER DR JOHN C ZIMMERMAN / OWNER Business Phone: (661}_663-8483x Business Phone: (661) 663-8483x- 24-Hour Phone ( ) - x 24-Hour Phone ( ) - ~ x Pager Phone (661} 345-4400x Pager Phone ( ) - x Hazmat Hazards: -React Contact LINDA GREESON Phone: (661) 663-8483x MailAddr: 9300 STOCKDALE HWY State: CA City BAKERSFIELD Zip 93309 - - ..Owner... DR JOHN C.ZIMMERMAN Phone:. (661) 663-8483x Address 9300 STOCKDALE HWY State: CA City_ BAKERSFIELD Zip :.93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ~~T!® T ~~ ~ X007 ?r!`~; rat:'~. ..,^r: C ^!'_'~'; -:,~. ~ .. -1- 07/11/2007 :~ ~ FOOT & ANKLE INSTITUTE SiteID: 015-021-002082 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP ~ WASTE FIXER R L 10.00 GAL Min -2- 07/11/2007 -3- 07/11/2007 F FOOT & ANKLE INSTITUTE SiteID: 015-021-002082 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ .COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: DARKROOM CAS# STATE ~- TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid I Waste ~mbient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum 5.00 GAL 10.00 GAL riHGH.KLVU~ 1.;V1~lYV1V~1V1J - %Wt. RS CAS# Silver No 7440224 t1AL,LitCL A5~~5.71~1t51V 1'S TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No .No. No/ Curies R. / / /. Min Daily Average 5.00 GAL -4- 07/11/2007 V F FOOT & ANKLE INSTITUTE SiteID: 015-021-002082 ~ ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 03/27/2007 1911 Employee Notif./Evacuation 03/27/2007 = VERBAL Public Notif./Evacuation 03/27/2007 VERBAL Emergency Medical Plan 03/27/2007 = 911, HOSPITAL -5- 07/11/2007 v ~ FOOT & ANKLE INSTITUTE SitelD: 015-021-002082 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention Release Containment 03/27/2007 SECONDARY CONTAINMENT Clean Up 03/27/2007 ABSORBANT FOR SMALL SPILLS AND 911 FOR LARGE SPILLS ~tner xesource xcLlvaLlon -6- 07/11/2007 ~F FOOT & ANKLE INSTITUTE SiteID: 015-021-002082 ~ ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ especial riazaras Utility Shut-Offs 03/27/2007 = GAS: N SIDE OF BLDG ELECTRICAL: N SIDE OF BLDG -WATER: S SIDE OF BLDG _ -Fire Protec./Avail. Water 03/27/2007 = FIRE EXTINGUISHERS AND SPRINKLERS rsuilaing occupancy Level - -7- o7/ii/2oo7 ~ << ~ ~~ F FOOT & ANKLE INSTITUTE SiteID: 015-021-002082 ~ Fast Format ~ ~ Training. Overall Site ~ Employee Training 03/27/2007 BRIEF St7NlMARY OF TRAINING PROGRAM: FOLLOW OSHA GUIDELINES Held for Future Use neiu zor ruzure use -8- 07/11/2007 :v F FOOT & ANKLE INSTITUTE Manager Location: 9300 STOCKDALE HWY City BAKERSFIELD CommCode: BFD STA 11 EPA Numb: BusPhone: Map 102 Grid: 32 SIC Code: DunnBrad: SiteID: 015-021-002082 (661) 663-8483 CommHaz Minimal FacUnits: 1 AOV: Emergency Contact / Title Emergency Contact / Title LINDA GREESON / DR JOHN C ZIMMERMAN / Business Phone: (661) 663-8483x Business Phone: (661) 663-8483x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone (661) 345-4400x Pager Phone ( ) - x Hazmat Hazards: React Contact LINDA GREESON Phone: (661) 663-8483x MailAddr: 9300 STOCKDALE HWY State: CA City BAKERSFIELD Zip 93309 Owner DR JOHN C ZIMMERMAN Phone: (661) 663-8483x Address 9300 STOCKDALE HWY State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ~~e ~aO7 Qased on my Inquiry pf fhoea in~ivldu2~is responsible for abt~ining the In;orma4i~an, I Certify under penalty of law th~et I have ~aersonally examined and am ;trmiiiar with the information submitted and 5siieve the information is true, ccurate, and complete. Z ~ '~~ Sign t~ re Date -1- 01/31/2007 u ,~ F FOOT & ANKLE INSTITUTE SiteID: 015-021-002082 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE FIXER R L 10.00 GAL Min -2- oi131/200~ -3- 01/31/2007 :) F FOOT & ANKLE INSTITUTE SiteID: 015-021-002082 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: DARKROOM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TWaste ~ Ambient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 10.00 GAL 5.00 GAL r~~rjtcLVU~ winr~lv~i~~l5 %Wt. RS CAS# Silver No 7440224 ti1~GHttL 1-~~ ~.C~J~1~1L' 1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 01/31/2007 F FOOT & ANKLE INSTITUTE SiteID: 015-021-002082 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification Employee Notif./Evacuation _,_ , ~ ,~ t U3.J 1 1 l~ 1V V l~ 1 1 ~ P~ V CL V UGL L 1 V l l B~IUCLy Clll: ~( L"LCU1l:d1 t'tdll -5- 01/31/2007 ,+ F FOOT & ANKLE INSTITUTE SiteID: 015-021-002082 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ itC 1C0..7C r1CVClll.l Vll 1CC 1CdCC L.Vll lid 111LLlCll 1. t.1Cd11 V~J ~Lner xesource Activation -6- 01/31/2007 ", .. F FOOT & ANKLE INSTITUTE SiteID: 015-021-002082 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .7LJCC:1d1 IldGdl. u5 Utility Shut-Offs ,_ r i.l.c r1v~.c~ . / r~vd11 . ~rva~.vs. D U11U111y VI: I: U~J d11Cr ~/ LC V C1 -7- 01/31/2007 J Y ` F FOOT & ANKLE INSTITUTE SiteID: 015-021-002082 ~ Fast Format ~ ~ Training Overall Site ~ Ldll~JlVyCC 11QJ.11111y Ydy C G 11C1U 1V.L rUI.UlC VAC I1C1V. LVl. 1'lIL UlC VAC -8- 01/31/2007 + FOC'I' & ANKLE INSTITUTE ______________________________ SiteID: 015-021-002082 + Manager Location: 9300 STOCKDALE HWY City BAKERSFIELD BusPhone: (661) 663-8483 Map 102 CommHaz Minimal Grid: 32 FacUnits: 1 AOV: CommCode: BFD STA 11 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title LINDA GREESON / DR JOHN C ZIMMERMAN / Business Phone: (661) 663-8483x Business Phone: (661) 663-8483x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone (661) 345-4400x Pager Phone ( ) - x Hazmat Hazards: React Contact Phone: (661) 663-8483x MailAddr: 9300 STOCKDALE HWY State: CA City BAKERSFIELD Zip 93309 Owner DR JOHN C ZIMMERMAN Phone: (661) 663-8483x Address 9300 STOCKDALE HWY State: CA City BAKERSFIELD Zip 93309 Period to Preparers Certif'd: ParcelNo: TotalASTs: _ TotalUSTs: _ RSs: No Gal Gal Emergency Directives: ~~' PROG H - HAZ WASTE GEN ( ~ ENT'6 J ~ L 2 6 2006 ~~ ~~ Based on my inquiry of those individuals responsible for obtaining the information, 1 cer4ify under penalty of law that 1 have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. 1Q~ s. e - ~_ -T- 05/09/2006 ~ .J' ::'-- ' ~ FOOT & ANKLE INSTITUTE /J-tf -D<-/ SiteID: 015-021-002082 , Manager : Location: 9300 STOCKDALE HWY City BAKERSFIELD CommCode: BAKERSFIELD STATION 11 EPA Numb: BusPhone: Map : 102 Grid: 32 (661) 663-8483 CommHaz : Minimal FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact LINDA GREESON Business Phone: 24-Hour Phone : Pager Phone / Title / (661) 663-8483x () x (fckj)~ -44OOx Emergency Contact / DR JOHN C ZIMMERMAN / Business Phone: (661) 24 -Hour Phone : ( ) Pager Phone : ( ) Title 663-8483x x x Hazmat Hazards: React Period Preparer: Certif1d: ParcelNo: to Phone: (661) 663-8483x State: CA Zip 93309 Phone: (661) 663-8483x State ,: CA Zip 93309 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Contact : MailAddr: 9300 STOCKDALE HWY City BAKERSFIELD Owner Address City DR JOHN C ZIMMERMAN 9300 STOCKDALE HWY BAKERSFIELD Emergency Directives: ~ß ,j_ "r:rlaf;:~e~::r.~DfJ heïcbv ¡çertify thai ,~ rw.v~~ (Typ" m print nmna) rnvie 'tied Ul~} ana,ched hazardous matêr¡~¡s mlã!K'lag&e> mellt plan for .~1~_., ~\~_8It¡d ~~~a* it ~!)n~ 'uìJo~h . \~~nð~ V$!na~) , , ~ any correctH;)I1~ c©nstltu~f8¡ a øm~!~~® ~n~ OOIT~~ MS\Iñì- agemani plan for Mlf facm~V 0 ~ ;- A!~~ j:~5;;::~:i~t:'~~tf~~ .~.;,~. '_2~~lo4- ,-' - - ' 'ba'f:/~ ~ -1- 08/13/2003 _'~ ,i .. F FOOT & ANKLE INSTITUTE f= Hazmat Inventory f== MCP+DailyMax Order SiteID: 015-021-002082 9 By Facility Unit 9 Fixed Containers at Site 9 specHaz EPA HazardS Frm DailyMax IUnit MCP Hazmat Common Name... WASTE FIXER R L 10.00 GAL Min -2- 08/13/2003 1;\ F FOOT & ANKLE INSTITUTE f= Inventory Item 0001 === COMMON NAME / CHEMICAL NAME WASTE FIXER SiteID: 015-021-002082 9 Facility Unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit INSIDE BOTH DARKROOMS Map: Grid: CAS# STATE - TYPE Liquid Waste PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 5.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 10.00 GAL Daily Average 5.00 GAL %Wt. I SlIver HAZARDOUS COMPONENTS ~ CAS # I 7440224 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min HAZARD ASSESSMENTS Treated On Site CA Code US Code GAL Generated/Mo. GAL Generated/Yr. No Treatment UnitID: I Unit Type: Agency-Defined Text Label WASTE DATA -3- 08/13/2003 <;0 SiteID: 015-021-002082 9 Fast Format 9 Overall Site 9 F FOOT & ANKLE INSTITUTE I f= Notif./Evacuation/Medical ~ Agency Notification Employee Notif./Evacuation [ I I Public Notif./Evacuation Emergency Medical Plan -4- 08/13/2003 ,^, SiteID: 015-021-002082 ì Fast Format ì Overall Site ì I I I I F FOOT & ANKLE INSTITUTE I f= Mitigation/Prevent/Abatemt r== Release Prevention Release Containment [ I I Clean Up Other Resource Activation -5- 08/13/2003 :- . . "" SiteID: 015-021-002082 9 Fast Format 9 Overall Site 9 I F FOOT & ANKLE INSTITUTE I f= Site Emergency Factors r== Special Hazards Utility Shut-Offs l I I Fire Protec./Avail. Water Building Occupancy Level -6- 08/13/2003 ./~ .' , .:J' Held for Future Use SiteID: 015-021-002082 ï Fast Format ì Overall Site ï I I I I F FOOT & ANKLE INSTITUTE I F Training r== Employee Training Page 2 ~ I I Held for Future Use -7- 08/13/2003 · , ,/UJ1l1x/,wql01lV ôlnpôfpSd.1ll1Y.¡,ôm llJfjl o,~ ôJIlI)(}P}) 1/l S.I110fj fr& lwa/ll1 sn ,CfiJOU DS1Jò/d '(Ç)JlWllIJl(lOildlJ.II1M: dòa~ OJ ò/qlJ111l ò.IIJ llaJJi ¡B 'S ' jE 't £ B jy. 'Z , I - ß , "I ~. . :¡if) Z{ÐIII.iPWUt.lZ ;¡~ q¡zm luautlll/odd/} UlJ S1Jq e w ~~ - .- :- =_--'::.~ /' , .. .. ""- ~ Dr.John C.Zimmérman , Podiatric Surgèon Foot & Ankle Institute A Podiatric Medical Group Gentle Treatment for: Heel and arch pain,· ~radures and spr~ins of the foot &-anklc ArÚ1ritis Bone a\,d joim disorders. Bunions' Hammertoes. Sports reial,d injuries logrown nails/nail & skin disorders· Corns, Gdluses and "'arlS . Diahetic foot care. . Inf:tJ1I & pediatricfootJankJe problems · Advanced Care , Arthroscopic snrgery for ankle and ¡oint problems' laser surgery - · _, ,Caring Servict ' a PPQs and jnsu.ranc~. \\:eJcome~ ~ Medicare provider. .visa and Ma$tcrcard act., Same-day appointments for emergencies' Flexible payment plans - ./ Dr. John C. Zimmerman Boa;d Certifled- American Board of Padianic Surgery Fellow: American CoHege of Foot and Ankle Surgery " Member: t~llerjcanhCalifornia and Midslate Podiatric Medica! Association American Academy of Podiatric Sports Medicine' American Podiatric Acùtroscopv A&sociat\on International Radiowave Sc!erotlierapy Society , Clillic,allnstructor: U,S,C, Medital Center, Podiatric Surgical Residency Program · 9300 Stockdale Highway, Suile 400· Ba,kersfidd, California 93311 - 661.663.8483' fax 661.663.3095 ' · 202 I V;ùk^' Boulevard. Tehachapi, Califomia 93561 661.822,55.\7 . fax 661.822.4307 / e e - ~:'37bl~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 1 o~-::,~ \ \ß FACILITY NAME f()o-r { ,ANKLé IN":. T'fL'íe ADDRESS ~ sOO $"'(VCXi)Aæ /:-fC-JV 1f::1Q:) FACILITY CONTACT VAJ<)A ~ INSPECTION TIME INSPECTION DATE fO (, g ("l..t:::IOO PHONE NO. ~, 3 -&4~> BUSINESS ID NO. 15-210- fVGcJ NUMBER OF EMPLOYEES "2-ô Section 1: Business Plan and Inventory Program o Routine SCombined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Appropriate penn it on hand ',?LC--ASE ~PLCíé 4 £c-rv2A1 Business plan contact infonnation accurate 'PC::al'k11 )rPPucAílcW RJR..n-t5 ("..h.~6J Visible address ~Q:: \ l) IN ,'fttç /'I..1..þ..''- ^' Correct occupancy -n~1L V()V¡ Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability Verification ofHaz Mat training Verification of abatement supplies and procedures Emergency procedures adequate ý' v Containers properly labeled f>£.C~ RrPI..A<.é LAßE<..s Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: 'Ø-Yes 0 No Explain: vJ~ 1'6 fl.kJ"Í~#tc.. F'iÞ(..~ e Party Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: W> /'\Ie ,:-_:~: ~.";"..>~__-~...;';r"n-=~:'~';:-~~.""""'''''~~:·'~:'~''-;;;_~~-;:;~1...~~::;.~.~,<,_,.m..1':~.~,-:..-·_"..........-.-,..".:~,._",..- '-'~-'__"'__""_"" _r. ~., ._.,.", -~-'"'_~ ,,__ _ _.... . . .>" '.,' ~-.::::.._,>;. r '.-"-"-Tr>.,-":'~:,--".,,~.·..~,~-:----~. .~-~ .~ . - ~\l~ ?7bl.O o1t .. .(>-,: i1t CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave.,3rd Floor, Bakersfield, CA 93301 1 0;;) j\ ~~ \ \ß FACILITY NAME f(.>o'r I( ,ÂNt.<U:-: IN)T,Tllíe ADDRESS ~ 3.00 S1"CX:.I(i)Â'£: ~c,I '\t'4fod FACILITY CONTACT i-tl'Jr)A ~S6.J - INSPECTION TIME INSPECTION DATE ' 'o/'8/~ PHONE NO. 166 J - g4~3 BUSINESS ID NO. 15-210- NGr....1 NUMBER OF EMPLOYEES '"2.0 Section 1: ", Business Plan and Inventory Program o Routine' SCombined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERA nON " C V COMMENTS Appropriate penn it on hand ?LC--ASE eðMpl..c-Té éf 1l.Gr~ÆAI Business plan contact infonnation accurate, " pl:.-12f'1<olr IcPPt...fcAf1cW Fc>t< I'PtS W f-I&J , tzéc \.J Visible' address tÑ ~ 114 Þ.'L ., Correct occupancy -rUAN ~ Vw/. 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 if' '" Containers properly labeled rLC4-Sé r<1=Pl AcE lAßé(.,5 Housekeeping .. " Fire Protection Site Diagram Adequate & On Hand :1 C=Compliance V=Violatiön Any hazardous, waste on site?: GlYesO No Explain:" ~"S. T6 fLkl'íQ5.l24PH'C- ',~I(.C..tt... Party Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: W>Néf5 to'" , " - CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~\ 1- þJl<{.é /NSn.,U'f€" INSPECTION DATE to(Ie:¡ !2.Þ~ Section 4: Hazardous Waste Generator Program EP A ID # o Routine .. Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EP A ID Number (Phone: 916-324-1781 to obtain EP A ID #) Authorized for waste treatment and/or storage Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondary containment provided V f~~sé P~V,QC ~VS Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels Proper management of used oil filters Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal C=Compliance V=Violation Inspector: Office of Environmental Services (661) 326-3979 White - Env. Svcs. fA.) (N'ES ....; ~ ~ \- ~~-~-= / ~~iness S~ Res~ble Party Pink-Businl~ ~ --" . CITY OF BAKERSFIELQa OFP!tE OF ENVIRONMENTAL SII.VICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION l ~ Äv-J'?LG- CHEMICAL LOCATION FACILITY ID # ~í6' f~~H-tc... ~ì<.GZ..- COMMON NAME . -. ._~~-" I CAS# , FIRE CODE HAZARD CLASSES (Complete it requested by local fire I t TYPE o P PURE o m MIXTURE PHYSICAL STATE o . SOUD ,JãU..auID FED HAZARD CATEGORIES o 1 FIRE 02 REÀCÏ1ve (Check all that apply) ANNUAL WASTE Gò 217 MAXlWM AMOUNT DAIL V AMOUNT %-wWASTE 211 RADIOACTIVE o Ves 0 No ogGAS 214 LARGEST CONTAI~ER s- 03 PRESsuRE RELEA5E . 04 Âëure tiËÃi.TH .-.' OS CHRONIC HEALTH 218 A~GE DAILV AMOUNT S;-' UNITS" ((j -. ogaGAL odCUFT . It ÐfS, amount mIlS! be in 1118. o Ib LBS o In TONS STORAGE CONTAINER (Check an that apply) ~ PLASTlCINONMETALLIC DRUM Of CAN o 9 CARBOV o h SILO o a ABOVEGROUND TANK Db UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEEL DRUM o FIBER DRUM OJ BAG Ok BOX 01 CYUNDER o m GlASS BOTTLE o n PlASTIC BOTTLE o 0 TOTE BIN D P TANK WAGON STORAGE PReSSURE iL AMBIENT o aa ABOVE AMBIENT o ba BELOW AMBIENT (one form per material per building or l118a) Page of 3 D Ves 0 No 202 204 I 210 i 212 CURIES 213 215 ! ! , 216 I 219 STATE WASTE CODE 220 221 DAYS ON SITE 222 o q RAIL CAR o r OTHER 223 224 STORAGE TEMPERATURE D. aa .~VE ~IE~'L__ o ba BELOW AMBIENT o C CRVOGENIC 225 . - --- .^ -. 226 227 Dves DNo 228 231 oVes_ DNo 232 235 oVesoNo 236 239 DVea DNo 240 . 243 -OÝ~-D~ '2'44-' 2 230 3 234 4 238 5 242 . - - . -- - ." - - . ~. --- - .u .. ~ --.------. >- - ---. --. _.~-- - --. 229 233 Z37 241 -'245 UPCf (7/99) S:\CUPAFORMS\OES2731.TV4.wpd