HomeMy WebLinkAboutBUSINESS PLAN 10/23/2006~ RIVERWALK DENTAL
__ __ _ 9330 STOCKDALE HWY, #500
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Prevention. Services
UNIFIED PROGRAM- INSPECTION CHECKLIST ~
a A F R S F t o 900 'Ihlxturi Ave.,- Suite 210
FiRF - Bakersfield, CA 93301
SECTLON 1: Business Plan and Inventory Program - i°Rr'" Tei.: (661) 326-3979
nn ~~/y ~ Fax: (661) 872-2171
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FACILITY N E INSPECTION DATE INSPECTION TIME
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ADDRESS - HONE NO. O OF~LOYEES
FACILITY CONTACT
~. ~uc3 ~~!7 BUSINESS ID NUMBER
15-021- GZ7Z f~~o
Section 1: Business Plan and Inventory Program ~ ~i ~'' go
ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION
C V ~ C=Compliance - OPERATION
V=Violation COMMENTS ~
^ .APPROPRIATE PERMIT ON HAND
^ BUSIfIeSS PLAN CONTACT INFORMATION ACCURATE .e ;
^ VISIBLE ADDRESS - ~ -.
CORRECT OCCUPANCY
^ VERIFICATION OF INVENTORY MATERIALS
^ VERIFICATION OF QUANTITIES
^ 'VERIFICATION OF LOCATION
^ PROPER SEGREGATION OF MATERIAL
^ VERIFICATION OF MSDS AVAILABILITY:
^ VERIFICATION OF HAZ MAT TRAINING
^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
^ EMERGENCY PROCEDURES ADEQUATE
4Y ^ CONTAINERS PROPERLY LABELED
^ HOUSEKEEPING - DT. ~_, f~ ~. D~~
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Dr. Lut
arcfa O. Perez. -----=
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tiverwalk dental Professionals
^ SITE DIAGRAM ADEQUATE & ON HAND ~ '9330 Stockdale Hwy., Suite 500
Bakersfield, CA 93311
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ANY HAZARDOUS WASTE ON SITE? YES ~IVC
EXPLAIN: - ~ - (661) 654-0758
Fax: (661)654-0136
® ® ShafterFamilyDentalCare
410 James Street
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',~ Shafter, CA 93263
(661) 746-3228
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QUESTIONS REGARDING THUS INSPECTION? PLEASE CALL US AT (661) 326-3979
Inspector. (Please Print) Fire Pr a tion / 1~` In /Shift of Site/Station # B iness Site / esponsible Party (Please Print) -
White -Prevention Services
Yellow -Station Copy
Pink- Business Copy
FD_2155 (Rev. 09/05
~ ^f ~~ - ~`+""" .Bakersfield Fire Dept.
UNIFIED PI~OGI2AM INSPECTION CHECKLIST 'Environmental Services
"~"`~°"~ 900 Truxtun Ave., Suite 210
SECTION 1 Business .Plan and Inventory Program Bakersfield, CA 933'
- ~ Tel: (661. 326 3979 ' ?~~j~
FACILITY NA ,~~ a INS*P~ESTION D E INSPECTION TIME
~~1„`l~ ~ Jl ~ l
ADDRESS PHONE No. No. of Employees
~ 3 ~ S~c~tan.~ ___ _ __ ___ _ _ ___ _ _
FACILITYCONTACT Business ID Number
15-021- ~.J
Section 1: Business Plan and Inventory Pn~gram ~ Zgg(~
O Routine O Combined D Joint Agency OMulti-Agency O Complaint O Re-
ANY HAZARDOUS WASTE ON SITE?: /~n-YES ^ NO
EXPLAIN: ~S ~ ~'0t-y `
QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT ~ss'I ~ 326-3979
~%~~
Inspector (Please Print) Fire Prevention 1st-In/Shik of Site
White -Environmental Snvices Yellow -Station Copy
Bu ess Site R sible Party (Please Print)
S
v ~
Pink - ttusinesa Copy
%T" -~~~~ CITY OF BAKERSFIELD FIRE DEPARTMENT
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FACILITY NAME ~•'`~'~~~. ~+~'~- INSPECTION DATE ~ l3 l ~ OS"
Section 4: Hazardous Waste Generator Program EPA ID # ^~~~"
^ Routine !~ Combined ^ Joint Agency ^hulti-Agency ^ Complaint ^ Re-inspection
OPERATION C V COMMENTS
Hazardous waste determination has been made Z.C.. 1 j'C~w~ C~G~..
EPA ID Number
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 aze kept closed when not in use
Weekly inspection of storage area
IgnitableJreactive waste located at least 50 feet from property line
Secondary containment provided
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
~=~ompuance v=vtotatton
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Inspector:
Office of Environmental Services (661) 326-3919
White -Env. Svcs.
OFFICE OF ENVIRONMENTAL SERVICES
•" UNIFIED PROGRAM INSPECTION CHECKLIST
` '~' ti ~ 1115 Chester Ave., 3'd Floor, Bakersfield, CA 93301
~~
Busines ite Responsible Party
Pink -Business Copy
~'"
B E R S F I D
FRB s, ;a e. [n
ARTM r
.%t..~y IL ~ ..d tT.....r_
~EW ^ ADD ^ DELETE
IUSINESS NAME (Same as FACILITY N.4N1E or
CHEMICAL LOCATION
Cn1S r J)~
CITY OF 11AKERSCIELD ,
OFFICE OF ENVLRONMENTAL SERVICES ~
1715 Chester Ave., CA 93301 (661) 326-3979 '
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HAZARDOUS MATERIALS INVENTORY ~
CHEMICAL DESCRIPTION
(one Porrn per material per building or area)
^ REVISE 200 Page _ of
_.-....._...-_.-._-._.-._._._.-... _. ...----_-. _. ..._... - .....-- ._ ..__.._.._._.__. ___---------- _ 1
-_ - I. FACILITY INFORMATION _ -
..-J
)BA-Doing~BusinessAS) ~~ 3 i
~'L QQ~-c.'SStca../Ats - - ---
D~jC r2C2jrt~ 201, CONFIDENTIOAL (EPCRA) ^ Yes ^ No 202
- ---~ - ~---~ i --~ ---- - 1I MAP # (oPtionaQ ~~_. .._- _ _ - ---~ ~- -- 203 ~ GRID # (optionan 204 ;
. ~
CHEMICAL NAME
- .~
II. CiiEMiCAL INFORMATION
205 TRADE SECRET ^ Yes ^ No 206
If Subjed to EPCRA, refer to instructions
COMMON NAME ~~,
EHS' ^ Yes ^ No
206
CAS # -, ..
209 •tf EHS rs'Yes alt amounts below must be in (bi.
FIRE CODE HAZARD CLASSES (Complete if requested by local ire chief)
210
--
--
-
-
TYPE -
^ pPURE ^ MIXTURE ,~w WAS7°_ ~.. , - -- - - - -----
-
-
-
~ R-J?IOACTIVc ^ Yes ^ No 212 j CURIES 213
PHYSICAL STATE ^ s SOLID L'1l~lOUID ^ g GAS 214 LARGEST CONTAINER ~ 215 i
i
FED HAZARD CATEGORIES ^ 1 FIRE ^ 2 REACTIVE ^ 3 PRESSURE RELE ASE ~ ACUTE HEALTH ^ 5 CHRONIC HEALTH 216
(Check all that apply)
ANNUAL WASTE ~ 217 w14XIMUh1 218
S AVERAGE 219 I STATE WASTE CODE
s 220 ;
AMOUNT DAILY AMOUNT ~ DAILY AMOUNT
i ~
UNITS' Y'-~ GAL ^ d CU FT ^ I b LBS ^ to TONS 221 ~ DAYS ON SITE 222 j
H
, amount must be in lbs.
If E
S I
STORAGE CONTAINER t
~
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^ a ABOVEGROUND TANKPLASTIC/NONMETALLIC DRUM ^ i FIBER DRUM ^ m GLASS BOTTLE ^ q RAIL CAR 223
(Check all that apply)
^ b UNDERGROUND TANK ^ f CAN C j BAG ^ n PLASTIC BOTTLE ^ r OTHER ~
^ c TANK INSIDE BUILDING ^ g CARBOY ^ k BOX ^ o TOTE BIN
^ d STEEL DRUM ^ h SILO ^ I CYLINDER ^ p TANK WAGON
i
STORAGE PRESSURE !~a AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT - 224
STORAGE TEMPERATURE fX .. gMBIENT ^ as ABOVE AMBIENT
~-° ^ ba BELOW AMBIENT ^ c CRYOGENIC 225
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- ~ HAZARDOUS COMPONENT
---- ~~EHS - :CAS # ~~~,
1 ~
226 ;
227 ; ^ ^ ~ ,
229 ~~
2
i
230
3 234
4 238
I
5
242
III. SIGNATURE
PRINT NAME 8 „ _ ____ _
TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE
~~
Yes No 228
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-_-_ --- ~-- - ------'•----- ----~-~---- -----~ ~
-- -
I
i
231 ^ Yes ^ No 232
I
233
-- ---%----..... -- -- ---
235 ^ Yes ^ No 236
i -
---
i
237
239 ^ Yes ^ No 240 241
243 i ^ Yes ^ No 244 ~ -~ _j
~ 245
_. --._...___.._. _ i _----- ~
DATE 246 J
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