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Home My WebLink AboutBUSINESS PLAN 11/19/2007 QUEST IMAGING MEDICAL ASSOCIATES ~~ 9602 STOCI~ALE HWY.--___--_-_ 6~ QUEST IMAGING MEDICAL ASSOCIATES ==================== SiteID: 015-021-003001 + Manager : ROXANNE WOLFE Location: 9602 STOCKDALE HWY City BAKERSFIELD BusPhone: Map : 102 Grid: 31D (661) 617-4015 CommHaz : Low FacUnits: 1 AOV: CommCode: BFD STA 11 SIC Code: EPA Numb: DunnBrad: +==============================================================================+ +=======================================+======================================+ Emergency Contact / Title Emergency Contact / Title ROXANNE WOLFE / COO / Business Phone: (661) 633-5000x4015 Business Phone:) x 24-Hour Phone : (661) 889-5115x 24-Hour Phone :) x Pager Phone () x Pager Phone ) x +---------------------------------------+--------------------------------------+ I Hazmat Hazards: Fire Press ImmHlth DelHlth I +------------------------------------------------------------------------------+ Contact : ROXANNE WOLFE Phone: (661) 633-5000x4015 MailAddr: PO BOX 2447 State: CA City : BAKERSFIELD Zip : 93303 +------------------------------------------------------------------------------+ Owner DRS CORNFORTH & FITZGERALD Phone: (661) 633-5000x Address : PO BOX 2447 State: CA City : BAKERSFIELD Zip : 93303 +------------------------------------------------------------------------------+ Period to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: +------------------------------------------------------------------------------+ Emergency Directives: PROG A - HAZMAT ~ased ,o,n my inguiry of those individuals ~dlJO/lSlbie for obla" ling the information I cerlt un er penalty of law that I hav . I Y :~~~:~:~ ~~~ ~~Ii~~~il;;~ f~~~r~:ti~Fr:~!~el~ ;;;:d;Z. ' r" ~ Ll-JtZP7~ gnalure Date LL-. ---i"e,atph,,;.,y '71 ,Pj. 8 0~ +==============================================================================+ -1- 11/14/2007 .+ QUEST IMAGING MEDICAL ASSOCIATES ==================== SiteID: 015-021-003001 + += Hazmat Inventory ========================================= By Facility Unit + +== MCP+DailyMax Order ============================== Fixed Containers at Site + +--------------------------------+-------+-----------+-----+----------+----+---+ I Hazmat Common Name... ISpecHazlEPA Hazards I Frm I DailyMax IUnitlMCpl +--------------------------------+-------+-----------+-----+----------+----+---+ OXYGEN F IH DH G 1506.00 FT3 Low HELIUM F P IH G 200.00 FT3 Min LIQUID HELIUM F IH L 55.00 GAL Min +==============================================================================+ -2- 11/14/2007 .+ QUEST IMAGING MEDICAL ASSOCIATES ==================== SiteID: 015-021-003001 + += Inventory Item 0001 =============== Facility Unit: Fixed Containers at Site + +== COMMON NAME / CHEMICAL NAME ==============================+================+ OXYGEN I Days On Site I 365 Location within this Facility Unit Map: Grid: +-----___________+ E SIDE OF BLDG SECURE RM I CAS # I 7782-44-7 +=============================================================+================+ += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+==== CONTAINER TYPE =====+ I Gas I Pure I Above Ambient I Ambient I PORT. PRESS. CYLINDER I +=========+==========+===============+===============+=========================+ +==========================+ AMOUNTS AT THIS LOCATION =========================+ I Largest Container I Daily Maximum I Daily Average I 251.00 FT3 1506.00 FT3 1506.00 FT3 +==========================+=========================+=========================+ +=======+============== HAZARDOUS COMPONENTS ==============+===+===============+ I %Wt. I I RSI CAS # I 100.00 Oxygen, Compressed No 7782447 +=======+==================================================+===+===============+ +=======+===+======+=========== HAZARD ASSESSMENTS ===+=========+========+=====+ I TSecretI RSIBioHazl Radioactive/Amo~t I EPA Hazards I NFPA I USDOT# I MCP I No No No No/ Curles F IH DH / / / Low +=======+===+======+====================+=============+=========+========+=====+ +========================== MISC. LOCAL AGENCY DATA ===========================+ Ag.Definedl: Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined7: Ag.Defined5: Ag.Defined6: Ag.Defined8: Ag.Defined9: Ag.Definel0: +- Ag.Definell ----------------------------------------------------------------+ +==============================================================================+ -3- 11/14/2007 + QUEST IMAGING MEDICAL ASSOCIATES ==================== SiteID: 015-021-003001 + += Inventory Item 0002 =============== Facility Unit: Fixed Containers at Site + +-- COMMON NAME / CHEMICAL NAME ------------------------------+-------------___+ -- ------------------------------ ---------------- HELIUM I Days On Site I 365 +----------------+ I CAS # I 7440-59-7 Location within this Facility Unit NE CRNR OF BLDG MRI RM Map: Grid: +=============================================================+================+ += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+==== CONTAINER TYPE =====+ I Gas I Pure I Above Ambient I Ambient I PORT. PRESS. CYLINDER I +=========+==========+===============+===============+=========================+ +==========================+ AMOUNTS AT THIS LOCATION =========================+ I Largest Container I Daily Maximum I Daily Average I 200.00 FT3 200.00 FT3 200.00 FT3 +==========================+=========================+=========================+ +=======+============== HAZARDOUS COMPONENTS ==============+===+===============+ I %-Nt . I ! RS I CAS # I 100.00 Helium No 7440597 +=======+==================================================+===+===============+ +=======+===+======+=========== HAZARD ASSESSMENTS ===+=========+========+=====+ I TSecretI RS!BioHazl Radioactive/Amo~t I EPA Hazards I NFPA I USDOT# I M~P I No No No No/ Curles F P IH / / / Mln +=======+===+======+====================+=============+=========+========+=====+ +========================== MISC. LOCAL AGENCY DATA ===========================+ Ag.Definedl: Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined9: Ag.Defined7: Ag.Definel0: Ag.Defined8: +- Ag.Definell ------------------------------------------------------------____+ +==============================================================================+ -4 - 11/14/2007 + QUEST IMAGING MEDICAL ASSOCIATES ==================== SiteID: 015-021-003001 + += Inventory Item 0003 =============== Facility Unit: Fixed Containers at Site + +== COMMON NAME / CHEMICAL NAME ==============================+================+ LIQUID HELIUM I Days On Site I RADIOISOTOPES 365 Location within this Facility Unit Map: Grid: +----------______+ E SIDE OF BLDG NUCLEAR MEDICINE DEPT I CAS # I +=============================================================+================+ += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+==== CONTAINER TYPE =====+ I Liquid I Pure I Ambient I Ambient I OTHER - SPECIFY I +=========+==========+===============+===============+=========================+ +==========================+ AMOUNTS AT THIS LOCATION =========================+ I Largest Container I Daily Maximum I Daily Average I 55.00 GAL 55.00 GAL 55.00 GAL +==========================+=========================+=========================+ +=======+============== HAZARDOUS COMPONENTS ==============+===+===============+ I %Wt. I I RSI CAS # I 100.00 Helium No 7440597 +=======+==================================================+===+===============+ +=======+===+======+=========== HAZARD ASSESSMENTS ===+=========+========+=====+ I TSecretI RSIBioHazl Radioactive/Amo~t I EPA Hazards I NFPA I USDOT# I M~P I No No No No/ Curles F IH / / / M1n +=======+===+======+====================+=============+=========+========+=====+ +========================== MISC. LOCAL AGENCY DATA ===========================+ Ag.Definedl: Ag.Defined2: Ag.Defined3: Ag.Defined4: Ag.Defined5: Ag.Defined8: Ag.Defined6: Ag.Defined9: Ag.Defined7: Ag.DefinelO: +- Ag.Definell -----------------------------------------------------___________+ +==============================================================================+ -5- 11/14/2007 .+ QUEST IMAGING MEDICAL ASSOCIATES ==================== SiteID: 015-021-003001 + +================================================================= Fast Format + += Notif./Evacuation/Medical ==================================== Overall Site + +== Agency Notification =========================================== 05/30/2007 + CALL 911, CALL EMS, NOTIFY ROXANNE WOLFE 661-889-5115. IF BUILDING IS OCCUPIED, ANNOUNCEMENT OF CODE RED IS CALLED AND ALL EMPLOYEES ASSIST PATIENTS TO THE NEAREST EXIT AND EVACUATE THE BUILDING. ALL EMPLOYEES AND PATIENTS MEET AT THE SOUTHEAST CORNER OF THE PARKING LOT BY STOCKDALE HWY. ROXANNE WILL DESIGNATE EMPLOYEES TO CONTACT EMS AND STERI-CYCLE TO PICK UP +==============================================================================+ +--- Employee Notl'f /Evacuatl'on ----------------------------------- 05/30/2007 + --- . ----------------------------------- ROXANNE WOLFE 889-5115 OR EMPLOYEE DISCOVERING DISASTER/FIRE WILL NOTIFY THE OPERATOR TO ANNOUNCE AN EVACUATION. +==============================================================================+ +---- Publl'C Notl'f /Evacuatl'on ------------------------------------ 05/30/2007 + ---- . ------------------------------------ ROXANNE WOLFE 889-5115 WILL NOTIFY SPECIFIC EMPLOYEES WHOM TO CONTACT. +==============================================================================+ +----- Emergency Medl'cal Plan ------------------------------------- 01/31/2006 + ----- ------------------------------------- IF THE FACILITY IS OCCUPIED, ALL TECHNICAL, NURSING AND PHYSICIAN STAFF WILL ASSIST AND STABILIZE ANY INJURED PARTIES UNTIL AMBULANCE SERVICE TRANSPORTS INJURED PARTIES TO MERCY SOUTHWEST HOSPITAL, LOCATED 1-1/2 BLOCKS AWAY. +==============================================================================+ -6- 11/14/2007 .+ QUEST IMAGING MEDICAL ASSOCIATES ==================== SiteID: 015-021-003001 + +================================================================= Fast Format + += Mitigation/Prevent/Abatemt =================================== Overall Site + +== Release Prevention ============================================ 05/30/2007 + OXYGEN CANISTERS ARE CHECKED DAILY FOR LEAKS. RADIOISOTOPES ARE CHECKED DAILY FOR LEAKS. HELIUM IS SELF-CONTAINED WITH ITS OWN EXHAUST TO OUTSIDE. +==============================================================================+ +--- Release Contal'nment ------------------------------------------ 03/24/2006 + --- ------------------------------------------ IN THE EVENT OF A SPILL OR LEAK, THE FOLLOWING PROCEDURES ARE FOLLOWED: SPILL AREA IS COVERED IN ABSORBANT MATERIAL AND THE AREA IS BLOCKED OFF OR QUARINTINED. IF RADIOISOTOPE IS SPILLED, THE AREA MAY BE EVACUATED AND EMERGENCY PERSONNEL NOTIFIED AND CLEANED ACCORDING TO THE MSDS SHEETS IF LEAK IS DETECTED AND FIXED OR EMERGENCY PERSONNEL NOTIFIED TO REPAIR, REPLACE LEAKY UNIT +==============================================================================+ +---- Clean Up ---------------------------------------------------- 03/24/2006 + ---- ---------------------------------------------------- CLEAN-UP IS ACCOMPLISHED IN ACCORDANCE WITH MSDS SHEETS. WHEN CLEANING UP SPILLS OR LEAKS. PROPER PPE IS WORN +==============================================================================+ +===== Other Resource Activation ==============================================+ I r +==============================================================================+ -7- 11/14/2007 ~+ QUEST IMAGING MEDICAL ASSOCIATES ==================== SiteID: 015-021-003001 + +================================================================= Fast Format + += Site Emergency Factors ======================================= Overall Site + +== Special Hazards =============================================== 01/31/2006 + STERI-CYCLE REMOVES ALL HAZARDOUS WASTE TWO TIMES A WEEK +==============================================================================+ +=== Utility Shut-Offs ============================================ 12/27/2006 + GAS: EQUIPMENT RM - SOUTHEAST SIDE OF BUILDING ELECTRICAL: EQUIPMENT RM -EAST EQUIPMENT ROOM WATER: EQUIPMENT RM --- SOUTH EQUIPMENT ROOM +==============================================================================+ , / 'I / / +==== Flre Protec. Aval . Water =================================== 12 27 2006 + FIRE EXTINGUISHERS. EMERGENCY. FIRE ALARM WILL NOTIFY FIRE DEPT IN EVENT OF AN +==============================================================================+ +===== Building Occupancy Level =================================== 12/27/2006 + 80 EMPLOYEES ! +==============================================================================+ -8- 11/14/2007 .+ QUEST IMAGING MEDICAL ASSOCIATES ==================== SiteID: 015-021-003001 + +================================================================= Fast Format + += Training ===================================================== Overall Site + +== Employee Training ============================================= 12/27/2006 + MSDS SHEETS ARE LOCATED IN EACH DEPARTMENT AND UPDATED WHEN NEW SUBSTANCES ARE INTRODUCED. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE TRAINED INITIALLY, ANNUALLY ON NEW JOB ASSIGNMENTS AND WHEN NEW MATERIALS ARE INTRODUCED INTO +==============================================================================+ +=== Page 2 ===================================================================+ I I +==============================================================================+ +==== Held for Future Use =====================================================+ I I +==============================================================================+ +===== Held for Future Use ====================================================+ I I +==============================================================================+ -9- 11/14/2007 . . ;:, r-, '~ •$ -VEST ImaR`in ~ MEDICAL'ASSOCIATES, Inc: - - ~ I www.questima.com •~ - ,~ " ~ Phil Buchanan ', ~ ,• . ~ : ~ ~ , , ,: Chief Operations Officer , ~ -,. ,. 9602 Stockddle H~ghwby , Bakersfield;;CA-93311.-' ~ ! I -`. ". :. Mail - P.O. Box 2447 , - 6,6'1-633-5000. ~~ ~" ~~ Bbkersfield CA 93303 -. Fax 661=633=2500 - '. r ~ _. QUEST IMAGING MEDICAL ASSOCIATES Manager ROXANNE WOLFE Location: 9602 STOCKDALE HWY City BAKERSFIELD CommCode: BFD STA 11 EPA Numb: BusPhone: (661) 617-4015 Map 102 CommHaz Low Grid: 31D FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title ROXANNE WOLFE / COO / Business Phone: (661) 633-5000x4015 Business Phone: ( ) - x 24-Hour Phone (661) 889-5115x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact ROXANNE WOLFE Phone: (661) 633-5000x4015 MailAddr: PO BOX 2447 State: CA City BAKERSFIELD Zip 93303 Owner DRS C & FITZGERALD Phone: (661) 633-S000x Address PO BOX 244 State: CA City BAKERSFIELD Zip 93303 Period to TotalASTs: = Gal Preparer : C'~~ ~~../ TotalUSTs : ~ ~ ~ ~ = Gal Certif'd: f RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ~~ those individuals i~guiry of 1 certify formatio ll y ersona ~;t,hrt~ tiro my in ;.-'e ok~l.~'I~iwgthat 1 have P formation ~~c~t~1~ ~ re r with the , ~h~1ty ~ under A - d e~, famtlia maUon is true, ~ etn inf ® ZOO Mp Y 3 ~ rxamine and h~l~eve the , CA1~ D ,~e Etta ~/ subm and complete. accur^ C ~ ~ lG f Date . g ature 5tis~o SiteID: 015-021-003001 -1- 05/16/2007 F QUEST IMAGING MEDICAL ASSOCIATES ~ Hazmat Inventory ~ MCP+DailyMax Order = SiteID: 015-0,21-003001 ~ By Facility Unit ~ Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F IH DH G 1506.00 FT3 Low HELIUM F P IH G 200.00 FT3 Min LIQUID HELIUM F IH L 55.00 GAL Min -2- 05/16/2007 -3- 05/16/2007 F QUEST IMAGING MEDICAL ASSOCIATES SiteID: 015-021-003001 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME OXYGEN ~ Days On Site 365 Location within this Facility Unit Map: Grid: E SIDE OF BLDG SECURE RM CAS# 7782-44-7 ~GaSATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE TPure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 251.00 FT3 1506.00 FT3 1506.00 FT3 HAZARDOUS COMPONENTS oWt. RS CAS# 100.00 Oxygen, Compressed No 7782447 tst~~t~tcL t~~ ~~aai~i~ivla TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME HELIUM Location within this Facility Unit NE CRNR OF BLDG MRI RM STATE TYPE PRESSURE _ Gas TPure Above Ambient Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 7440-59-7 TEMPERATURE CONTAINER TYPE Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 200.00 FT3 200.00 FT3 200.00 FT3 ntiatitcLVU~ ~.vinrvtvnlvt~ ~Wt. RS CAS# 100.00 Helium No 7440597 nxa. ucL s-~a a r~ ~ ~-~ir,ly 1 a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -4- 05/16/2007 .. F QUEST IMAGING MEDICAL ASSOCIATES ~ Inventory Item 0003 COMMON NAME / CHEMICAL NAME LIQUID HELIUM RADIOISOTOPES Location within this Facility Unit E SIDE OF BLDG NUCLEAR MEDICINE DEPT STATE TYPE PRESSURE Liquid TPure -~ Ambient SiteID: 015-021-003001 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# TEMPERATURE CONTAINER TYPE Ambient OTHER - SPECIFY AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 55.00 GAL r~~r~tcL~uS ~vi~irc~lv~iv-1-~ ~Wt. RS CAS# 100.00 Helium No 7440597 t1EjG1~tCL HJJL' 771~11"~1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / Min -5- 05/16/2007 F QUEST IMAGING MEDICAL ASSOCIATES SiteID: 015-021-003001 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 01/31/2006 CALL 911, CALL EMS, NOTIFY ROXANNE WOLFE AT 661-889-5115 IF BUILDING IS OCCUPIED, ANNOUNCEMENT OF CODE RED IS CALLED AND ALL EMPLOYEES ASSIST PATIENTS TO THE NEAREST EXIT AND EVACUATE THE BUILDING. ALL EMPLOYEES AND PATIENTS MEET AT THE SOUTHEAST CORNER OF THE PARKING LOT BY STOCKDALE HIGHWAY. ROXANNE WILL DESIGNATE EMPLOYEES TO CONTACT EMS AND STERI-CYCLE TO PICK UP SPILLS. 9 Employee Notif./Evacuation 01/31/2006 ROXANNE WOLFE AT 661-889-5115 OR EMPLOYEE DISCOVERING DISASTER/FIRE WILL NOTIFY THE OPERATOR TO ANNOUNCE AN EVACUATION. Public Notif./Evacuation 01/31/2006 ROXANNE WOLFE AT 661-889-5115 WILL NOTIFY SPECIFIC EMPLOYEES WHOM TO CONTACT Emergency Medical Plan 01/31/2006 IF THE FACILITY IS OCCUPIED, ALL TECHNICAL, NURSING AND PHYSICIAN STAFF WILL ASSIST AND STABILIZE ANY INJURED PARTIES UNTIL AMBULANCE SERVICE TRANSPORTS INJURED PARTIES TO MERCY SOUTHWEST HOSPITAL, LOCATED 1-1/2 BLOCKS AWAY. -6- 05/16/2007 c, ' F QUEST IMAGING MEDICAL ASSOCIATES SiteID: 015-021-003001 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 01/31/2006 ~ OXYGEN CANISTERS ARE CHECKED DAILY FOR LEAKS RADIOISOTOPES ARE CHECKED DAILY FOR LEAKS HELIUM IS SELF-CONTAINED WITH ITS OWN EXHAUST TO OUTSIDE Release Containment 03/24/2006 IN THE EVENT OF A SPILL OR LEAK, THE FOLLOWING PROCEDURES ARE FOLLOWED: SPILL AREA IS COVERED IN ABSORBANT MATERIAL AND THE AREA IS BLOCKED OFF OR QUARINTINED. IF RADIOISOTOPE IS SPILLED, THE AREA MAY BE EVACUATED AND EMERGENCY PERSONNEL NOTIFIED AND CLEANED ACCORDING TO THE MSDS SHEETS IF LEAK IS DETECTED AND FIXED OR EMERGENCY PERSONNEL NOTIFIED TO REPAIR, REPLACE LEAKY UNIT Clean Up 03/24/2006 CLEAN-UP IS ACCOMPLISHED IN ACCORDANCE WITH MSDS SHEETS. PROPER PPE IS WORN WHEN CLEANING UP SPILLS OR LEAKS. Other Resource Activation -7- 05/16/2007 ~, F QUEST IMAGING MEDICAL ASSOCIATES SiteID: 015=021-003001 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~ Special Hazards 01/31/2006 ~ STERI-CYCLE REMOVES ALL HAZARDOUS WASTE TWO TIMES A WEEK Utility Shut-Offs 12/27/2006 GAS: EQUIPMENT RM ELECTRICAL: EQUIPMENT RM WATER: EQUIPMENT RM Fire Protec./Avail. Watez 12/27/2006 FIRE EXTINGUISHERS. FIRE ALARM WILL NOTIFY FIRE DEPT IN EVENT OF AN EMERGENCY. FIRE HYDRANT ACROSS FRONT OF PARKING LOT ON STOCKDALE HWY SOUTH. Building Occupancy Level 80 EMPLOYEES 12/27/2006 -8- 05/16/2007 a ,:. ,a,-' F QUEST IMAGING MEDICAL ASSOCIATES SiteID: 015-021-003001 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 12/27/2006 ~ MSDS SHEETS ARE LOCATED IN EACH DEPARTMENT AND UPDATED WHEN NEW SUBSTANCES ARE INTRODUCED. BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE TRAINED INITIALLY, ANNUALLY ON NEW JOB ASSIGNMENTS AND WHEN NEW MATERIALS ARE INTRODUCED INTO THE WORKSITE. rctyC L riciu iva. rui.u.~c vac nciu ivi ru~.utc vac -9- 05/16/2007 Prevention Services UNLFIED PROGRAM INSPECTION CHECKLIST' A F R s ~ , . n 90oTruxtun Ave., Suite 210 - - - _ - _ FIRE Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program aesM r Tel.: (661) 326-3979- -Fax: (661) 872-2.171 FACILITY NAME INSPECTION DATE INSPECTION TIME ADDRESS PHONE NO. NO OF RLOYEES- ~ a Z out 33 ~C~~ ~U FACILITY CONTACT ~ BUSINESS'ID NUMBER 15-021- b03b0 / o ~./ ~~ -- / t L/~ Section 1: Business Plan and Inventory. Program `~ 1~ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance -OPERATION V=Violation COMMENTS - ^ APPROPRIATE PERMIT ON HAND ~f LrJ ^ BUSIC1eSS PLAN CONTACT INFORMATION ACCURATE ,'~ ~r ^ VISIBLE ADDRESS CY ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ~/ L'~J' ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE LE Y ^ CONTAINERS PROPERLY LABELED ~ / +L~ ^ I'~OUSEKEEPING ^ .FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: Inspector (Please Print) ^ YES ~ NO T I IINSPECTION? Lease cnLL us nr (661) 326-3979 _ t l C._, ~C,~, _.-. FireFire Pre~r In /Shift of ite/Station # u ' ess Site / Responsi a Party (Please Print) White.- Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09105 s + QUEST IMAGING MEDICAL ASSOCIATES ____________________ SiteID: 015-021-003001 + Manager ROXANNE WOLFE Location: 9602 STOCKDALE HWY City BAKERSFIELD BusPhone: (661) 617-4015 Map 102 CommHaz Low Grid: 31D FacUnits: 1 AOV: CommCode: BFD STA 11 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title ROXANNE WOLFE / CHIEF OPER OFF / Business Phone: (661) 633-5000x4015 Business Phone: ( ) - x 24-Hour Phone (661) 889-5115x 24-Hour Phone ( ) - x Pager Phorie ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : ROXANNE WOLFE Phone: (661) 633-5000x4015 MailAddr: PO BOX 2447 State: CA City BAKERSFIELD Zip 93303 Owner DRS COMFORTH & FITZGERALD Phone: (661) 633-5000x Address PO BOX 2447 State: CA City BAKERSFIELD Zip 93303 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ PROG A - HAZMAT Eased an my inquiry of those individuals responsible for obtaining the information, I certify exam ned anid am familiaa with the information submitted and believe the information is true, accur e, and complet . Signature Date ENT's ~a~ ~ 4 Zoos -1- 03/13/2006 ;, . f~ F l ` ~~ IJ ` l ~ }: ~., ,a ... :;~ r' ?~ i ~ ~ ~. + •9 I ~-„1 'J Q ..~ i+ l~ ~,~t.~ r ~ ~~ ~'~ V~ ~C-~'(. ~'1 ~lSfrl2v 5 ~_-__, 1 .° 'Q ~.,~- tt f v ~., ~Q _ .1 .:,~ti. ~'•.':.. F' T ~...-~ ,M:: -=-• ~ z ~` T ~.. . ..: T , ._ ` w ~ ~ T H ~ ~ ~ p_ ~ 3 ,, ~ a ~, ~ ~ ~~,.~ ~ 1 r ~. ! 5 .- .~~;, ~® ~ :. k _ '~ ~ _ p F :.. µ ~ ~. ,~ `` .~ (/D -/^'/A' ~ 1 yt'.ff if.~. ~. .i~~..iA~f i.~..~L~:.4~r.. ~.~ 1 Ji ~..1 A.. ~`+ OV QUEST IMAGING MEDICAL ASSOCI~ITES ~ EAKERSFIELD, CALIFORNIA ~, UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan~and Inventory Program FACILITY ADDRESS FACILITYCONTACT Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel: (661) 326-3979 -_-_ _ _ _ INSPEQ `IONp~TE INSPECTION TIME ...,. ~~ z. Vumbx IS- 1- ~~ Section 1: Business Plan and Inventory Program ~ ~ 1 ^ Routine ^ Combined O Joint Agency OMulti-Agency ^ Complaint ^ Re-In c Ion C V atonnCel OPERATION lV=vi COMMENTS p~ ,~~ ~ o l ^ ^ APPROPRIATE PERMIT ON HAND ~- ~ \ t~ ^ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ ^ VISIBLE ADDRESS ^ ^ CORRECT OCCUPANCY ^ ^ ~ VERIFICATION OF INVENTORY MATERIALS ~~Y~~ ^ ^ VERIFICATION OF QUANTITIES ~~ ~ .X ^ ^ .VERIFICATION OF LOCATION dt.l~S -Q ~ . t ~ ~~ ~ ~" ¢L f~i~ ^ ^ PROPER SEGREGATION OF MATERIAL ^ ^ VERIFICATION OF MSDS AVAILABILITYE ,~ I ~,I v` ®~ ' ~ " ^ ^ VERIFICATION OF HAT MAT TRAINING ~ ~{l'd. y l~ ^ - ~-- ^ ---- VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES -_ _ - - -- -- ------ ------- -- ---- __ _- . _. _ --- -- - ~ . _ _ .. _ - _ ~ ~ ~D ^ ^ EMERGENCY PROCEDURES ADEQUATE ~ . ^ ------ ^ ---...----._..----------------._ --.. ------ ------------------...._._... CONTAINERS PROPERLY LABELED I -- - . .... .......... __ } --- ....-...--.--.._. _...-.._....__._.. .._ .. ------_ - - --- ....._ ^ ^ - HOUSEKEEPING _..... - _ .. ._. _ _ ^ ^. FIRE PROTECTION I~I ^ ^ SITE DIAGRAM ADEQUATE S ON HAND ANY HAZARDOUS WASTE ON SITE?: YES ^ NO EXPLAIN: QUESTIONS REGARDING THIS INSPECTIONZ PLEASE CALL US AT tGB'I ~ 326-3979 Inspector (Please Print) Fire Prevention 1st-In/Shik of Site WhRe -Environmental Services Velbw -Station Copy usiness Site Responsible Party (Please Print) Pink -Business Copy ~, B E R S F I D PllirB Ali<TM r ^ ADD ^ DELETE CITY OF I~AKERSFIELD .. OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 _ ~, • ~~,~~» HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one loan per material per bul/dinq orareaJ ^ REVISE 200 Page _ of _ - ,' -- I FACILITY If1~FORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 9 i ~(9C-5~ ~n.~/-~Gr~G pp CHEMICAL LOCATION ~S t~~ N.~ L!'~/v2 l.J'Ir p1L0`y FACILITY ID # --~ 1 -----~ ~ -, -C-- i 1I -MAP # (optionaq------- I i t CHEMICAL NAME ~~~ `` ``'' -- II `l_J~CC~JV 20t CHEtA1CAL LOCATION ^ Yes ^ NO 202 I CONFIDENTIAL (EPCRA) ~ -- 203 ) GRID # (ophonan 204 '~ IL C7iEMICAL INFORMATION - COMMON NAME CAS # __ __ _ - ---. - 205 i TR,4DE SECRET ^ y~ ^ No 206 ' If Subject to EPCRA, refer to instructions ~- - -------- -- .. - -- 207--~'--- ---- -- EHS` ^ Yes ^ No 208 I. 209 ~ 'If EHS is`Yes,' all amounts below mtui be in Ibs. local fire chief) - - -_-._. - -------..._.--- 210 TYPE PURE ^ m MIXTURE ^ w WASTE i- ; R-~DIOACTIVE ^ Yes ^ No 212 ~ CURIES j 213 PHYSICAL STATE ^ s SOLIO ^ I LIQUID ~ GAS 214 LARGEST CONTAINER Z~- ~ 215 i I FED HAZARD CATEGORIES ~p ^ 1 FIRE ^ 2 REACTIVE Lt~'9~PRESS:JRE RELEt, f ~ SE ~ 4 4:1UTE HEALTH ^ 5 CHRONIC HEALTH ~ 216 (Check alI that apply) . ANNUAL WASTE ---- - -'- ----- - wt.4XIMUht - ------ )~y~G " 418 ~ 217 (( ~/ CC A.VERAGE I S~I, -- - -- 219 j STATE WASTE CODE 220 i ' AMOUNT JJ . ~ DAILY AMOUNT DAILY AMOUNT I ~ UNITS' ^ ga GAL p~d CU FT ^ Ib LBS ^ to TONS 221 i DAYS ON SITE 222 ` If EHS, amount must be in Ibs. ~ ~ ~ STORAGE CONTAINER ^ a ABOVEGROUND TANK ^ e PLASTIC/NONMETALLIC DRUM ^ i FIBER DRUM ^ m GLASS BOTTLE ^ q RAIL CAR 223 I (Check all that apply) ~ ^ b UNDERGROUND TANK ^ f CAN ^ j BAG ^ n PLASTIC BOTTLE ^ r OTHER ^ c TANK INSIDE BUILDING 0 g CARBOY ^ k BOX ^ o TOTE BIN ^ d STEEL DRUM ^ h SILO CYLINDER ^ p TANK WAGON STORAGE PRESSURE ^ a AMBIENT ~a ABOVE AMBIENT ^ ba BELOW AMBIENT 224 STORAGE TEMPERATURE ~L~e AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT ^ c CRYOGENIC 225 °WT =- ~- - - ~ HAZARDOUS,COMPONENT =_ _~ = = - - - - EHS - CAS # 1 T 226 _ - ------ ----- - ----- _ _ ___ - ~ -------- 227 ~ ^ Yes ^ No 228 229 ---- i t------ --------- ----- ~---~-- ~-------------._--- ---- _. - --- i - -... ... - . ----~- ---------------...-- - - ii I 2 230 i 231 ^ Yes ^ No 232 ~ 233 ; i ---- - -- --- -- -- ---- - ---- i I 3 ' 234 I 235 ^ No 236 ~ ^ Yes ~ 237 ,1 i _ . --- 4 I I 238 239 i ^ Yes ^ No 240 241 I 5 242 - ----- 243 i ~ ^ Yes ^ No 244 245 j i III SIGNATURE SIGNATURE - DATE 246 , /' - 4 ~t ~6 I' - -- - ------------ r UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd