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HomeMy WebLinkAboutBUSINESS PLAN 9/4/2007~~ ~ ` ~ ~ ~'` ~ ~~ MERC ~ "HOSPITAL ~ ~•• ~ • ~~ ~ ~~ 2215 TRUXTUN AVENUE ~~ ~`~~ ~. ~-~ ;, _ . _ _ ~. - ~. , t ~+ ~ ~ ~ • ~ ~ , ~ ~ i`) ~' ~ • ~. ~ -- ~ ~i ~ ,. .. ~~ : J ~ '~ A•'J A"i ~i~ r - - ~. ~~ ~ ~ • ~~ ~,, ~ ~~~ ,~ „. -- :~- c •. ....~. ~J~ t ~1 . d: 1 i ~~' i ~ '' , I i~ ~`~~` • , ~}~ ~~-i ~~~ ~,~ ' ~~ ~. ~J =_._ _. ;;.~ - - _, MERCY HOSPITAL SiteID: 015-021-000628 Manager KEVIN KLOCKENERA Location: 2215 TRUXTUN AVE City BAKERSFIELD BusPhone: (661) 632-5503 Map 102 CommHaz High Grid: 25D FacUnits: 34 AOV: CommCode: BFD STA O1 EPA Numb: CAD981400237 SIC Code:8062 DunnBrad:95-166-0858 Emergency Contact / Title Emergency Contact / Title KEN LABRECQUE / ADMIN DIRECTOR KEN STONECIPHER / FACILITY DIR Business Phone: (661) 632-564 2x Business Phone: (661) 632-5872x 24-Hour Phone (661) 632-500 0x 24-Hour Phone (661) 632-5000x Pager Phone ( ) - x ~ - c ~- Hazmat Hazards: RSs Fire Press React ImmHlth DelHlth Contact KEN LABRECQUE Phone: (661) 632-5642x MailAddr: 2215 TRUXTUN AVE State: CA City BAKERSFIELD Zip 93301 Owner CATHOLIC HEALTHCARE WEST Phone: (415) 438-5550x Address 185 BERRY ST 300 State: CA City SAN FRANCISCO Zip 94107 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif~d: RSs: Yes ParcelNo: Emergency Directives: ~N~9~ ~ ~~ ~` ~ ~~~~ PROG A - HAZMAT PROG C - COMM HOOD PROG H - HAZ WASTE GEN PROG U - UST Based on my incpuiry of those individuals responsible for obtaining the information, I r ,ertity . under penalty of ia~~r tha# I have personally examined and am familiar v~ith the information submitted and relieve the information is true , accurate, and complete. i ~~ gnat r - Date -1- 07/12/2007 :r >- s F MERCY HOSPITAL SiteID: 015-021-000628 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: •• FACILITY/SITE INFORMATION Business Name: MERCY HOSPITAL Cross Street Business Type: Org Type: Total Tanks IndnRes/Trust: No PA Contact: Dsg Own/Oper BRETT A. TACKET ICC Nbr: 5243805-UC PROPERTY OWNER INFORMATION Name KEN STONECIPHER Phone: (661) 632-5872x Address: City State: Zip: Type TANK OWNER INFORMATION Name KEN STONECIPHER Address: City Type BOE UST Fee# Financ'1 Resp: Legal Notif Date: Name: State UST # Phone: (661) 632-5872x State: Zip: Phone: ( ) Ttl: 1998 Upg Cert#: x -2- 07/12/2007 ,. :~ F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order EXTERIOR CAMPUS ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP KATHON LM F IH L 30.00 GAL Mod DIESEL F IH DH L 8000.00 GAL Low OXYGEN F P IH G 3600.00 FT3 Low WASTE OIL F DH L 55.00 GAL Low -3- 07/12/2007 :F ! F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order MAIN BLDG 1ST FLOOR ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP ACETYLENE 130 E F P IH G 1300.00 FT3 Hi ALCOHOL IH L 10.00 GAL Mod OXYGEN 281 F P IH G 5620.00 FT3 Low CHLORODIFLOUROMETHANE F P IH G 1116.00 FT3 Low CARBON DIOXIDE USP, OXYGEN USP F P IH G 425.00 GAL Low NITROGEN 304 F P IH G 6080.00 FT3 Min DICHLORODIFLOROMETHANE F P IH G 635.00 FT3 Min -4- 07/12/2007 F MERCY HOSPITAL SitelD: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order MAIN BLDG 2ND FLOOR ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP XENON, XE 133 GAS F P IH G 250.00 FT3 Min -5- 07/12/2007 J ~ F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order WEST TOWER 1ST FLOOR ~ Hazmat Common Name... ISpecHazIEPA Hazards) Frm I DailyMax IUnitIMCPI SUN GLOH L 48.00 GAL UnR~ -6- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order WEST TOWER 2ND FLOOR ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F P IH G 46.00 FT3 Low -7- 07/12/2007 .~ ~ ~' F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order WEST TOWER 3RD FLOOR ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F P IH G 23.00 FT3 Low -8- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order WEST TOWER 4TH FLOOR ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F P IH G 92.00 FT3 Low -9- 07/12/2007 F MERCY HOSPITAL ~ Hazmat Inventory = ~ MCP+DailyMax Order SitelD: 015-021-000628 ~ By Facility Unit ~ = WEST TOWER 5TH FLOOR ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F P IH G 23.00 FT3 Low -10- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order TREATMENT/DIAGNOSTIC 1ST FLO ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP HYDROGEN/CARBON DIOXIDE/NITROGE E F P IH G 100.00 FT3 Ext NITROUS OXIDE F P IH G 200.00 FT3 Hi ALCOHOL DH L 48.00 GAL Mod ALCOHOL DH L 32.00 GAL Mod COMPRESSED AIR 250CF F P IH G 2000.00 FT3 Min HELIUM NON-FLAMMABLE P IH G 1250.00 FT3 Min NITROGEN NON-FLAMMABLE P IH S 500.00 LBS Min COMPRESSED GAS NON-FLAMMABLE 25 P IH G 1500.00 FT3 UnR -11- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order TREATMENT/DIAGNOSTIC 2ND FLO ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP CO2/H2/N2 CO2/N2 E F P F P IH IH G G 209.00 209.00 FT3 FT3 Ext Min -12- 07/12/2007 F MERCY HOSPITAL ~ Hazmat Inventory = ~ MCP+DailyMax Order SiteID: 015-021-000628 ~ By Facility Unit ~ TREATMENT/DIAGNOSTIC 4TH FLO ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE F P IH G 700.00 LBS Hi OXYGEN COMPRESSED F P IH G 23.00 FT3 Low -13- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order CARDIAC REHAB CENTER ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP ALCOHOL, ISOPROPYL DH L 1.00 GAL Mod -14- 07/12/2007 F MERCY HOSPITAL ~ Hazmat Inventory = ~ MCP+DailyMax Order SiteID: 015-021-000628 ~ By Facility Unit ~ MRI ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP PHOTOGRAPHIC FIXERS R IH L 239.00 GAL Mod HELIUM F P IH DH G 22407.00 FT3 Min NITROGEN P R IH G 6312.00 FT3 Min -15- 07/12/2007 -i6- o~/ia/aoo~ I F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0003 Facility Unit: EXTERIOR CAMPUS ~ COMMON NAME / CHEMICAL NAME KATHON LM Days On Site MICROBIOCIDE 365 Location within this Facility Unit Map: Grid: EXT TO BOILER RM CAS# TATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~mbient ~ Ambient OTHER - SPECIFY AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 30.00 GAL 30.00 GAL 30.00 GAL HAZARDOUS COMPONENTS °sWt . RS CAS# t11~GHKL L-1J ~~.7~1~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / Mod ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME DIESEL Location within this Facility Unit S OF BOILER ROOM STATE TYPE PRESSURE _ Liquid TMixture ~mbient AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 8000.00 GAL 8000.00 GAL 4000.00 GAL nti~rucLVU~ ~.vrirvlvalvla °sWt . RS CAS# 100.00 Fuel Oil No. 1 No 70892103 nt~arucy t~~ ~r,a~ri~ty 1 a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low Facility Unit: EXTERIOR CAMPUS ~ Days On Site 365 Map: Grid: CAS# TEMPERATURE ~~ CONTAINER TYPE Ambient I UNDER GROUND TANK -17- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0001 Facility Unit: EXTERIOR CAMPUS ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: A ST CAS# 7782-44-7 ~GasATE T TYPE PRESSURE TEMPERATURE CONTAINER TYPE I Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum ~ Daily Average 3600.00 FT3 3600.00 FT3 1800.00 FT3 r~~t~tcLwa winr~lv~ly l a °~oWt. RS CAS# 100.00 Oxygen, Compressed No 7782447 t11~GHKL H.7.7~7A1"l~lv1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH j / / Low ~ Inventory Item 0004 COMMON NAME / CHEMICAL NAME WASTE OIL Location within this Facility Unit EXT NEXT TO HW STORAGE Facility Unit: EXTERIOR CAMPUS ~ Days On Site 365 Map: Grid: CAS# 221 Liquid TWaste ~mbient~E ~ AmbientT~E DRUM/BARRELEMETALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 50.00 GAL nhGtucLVUa ~.vrirvivr,lvla °sWt. RS CAS# 100.00 Waste Oil, Petroleum Based No 0 IIHGHCtL 1-~~ ,~iS~7J1~1.G1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low -18- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0007 Facility Unit: MAIN BLDG 1ST FLOOR ~ COMMON NAME / CHEMICAL NAME ACETYLENE 130 Days On Site 365 Location within this Facilit Unit M G id y ap: r : BOILER ROOM CAS# 74-86-2 ~GaSATE TYPE TPure PRESSURE ~ Above Ambient ATE~MPeRATURE ~ CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 330.00 FT3 1300.00 FT3 650.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Acetylene Yes 74862 l1L~iGtilCL Ya. 7 A P~ J i71•1LilV 1 .7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0010 Facility Unit: MAIN BLDG 1ST FLOOR ~ COMMON NAME / CHEMICAL NAME ALCOHOL Days On Site 365 Location within this Facility Unit Map: Grid: RESPIRATORY THERAPY CAS# 67-63-0 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 10.00 GAL 5.00 GAL ruyc~tuctw~o l.Vllt'V1VL~1ViJ oWt. RS CAS# 70.00 Isopropyl Alcohol No 67630 ruyc~ruct~ na aaaJrir,iv t J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / Mod -19- 07/12/2007 F MERCY HOSPITAL SitelD: 015-021-000628 ~ ~ Inventory Item 0006 Facility Unit: MAIN BLDG 1ST FLOOR ~ A COMMON NAME / ME CHEMICAL N OXYGEN 281 Days On Site 365 i ili i G id s Fac ty Un t Location within th Map: r : BOILER RM CAS# 7782-44-7 ~GdSATE TYPE TPure PRESSURE Above Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION - Largest Container Daily Maximum Daily Average 281.00 FT3 5620.00 FT3 2810.00 FT3 nx~tutl~uuJ ~.vlnr~lv~lvaS gWt. RS CAS# 100.00 Oxygen, Compressed No 7782447 t1E~GHKIJ E~55~JJ1~1~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low ~ Inventory Item 0004 COMMON NAME / CHEMICAL NAME CHLORODIFLOUROMETHANE Location within this Facility Unit BOILER RM Facility Unit: MAIN BLDG 1ST FLOOR ~ Days On Site 365 Map: Grid: CAS# 75-45-6 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Mixture TAbove Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 1116.00 FT3 558.00 FT3 HAZARDOUS COMPONENTS °sWt. RS CAS# 100.00 Chlorodifluoromethane No 75456 I11iGKRL H. 7 J1:,.'~iJ1~11;1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -20- 07/12/2007 F MERCY HOSPITAL SiteTD: 015-021-000628 ~ ~ Inventory Item 0011 Facility Unit: MAIN BLDG 1ST FLOOR ~ COMMON NAME / CHEMICAL NAME CARBON DIOXIDE USP, OXYGEN USP Days On Site 365 Location within this Facility Unit Map: Grid: RESPIRATORY THERAPY CAS# 124-35-9 ~GaSATE ~ TYPE ~AboReSAmbEent TEMPERATURE CONTAINER TYPE Mixture I ~ Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 425.00 GAL 425.00 GAL 80.00 GAL - ti1~GH1~LVU5 LV1~lYV1VJ;1V1.7 %Wt. RS CAS# 5.00 Carbon Dioxide No 124389 95.00 Oxygen, Compressed No 7782447 IIHGKKL L3~AJ;.`~~71~11;1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low ~ Inventory Item 0005 COMMON NAME / CHEMICAL NAME NITROGEN 304 Location within this Facility Unit STORAGE RM IN HALLWAY Facility Unit: MAIN BLDG 1ST FLOOR ~ Days On Site 365 Map: Grid: CAS# 7727-37-9 STATE T TYPE ~~ PRESSURE ~~ TEMPERATURE Gas I Mixture I Above Ambient I Ambient CONTAINER TYPE _ PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 255.00 FT3 6080.00 FT3 3040.00 FT3 ruiarstu~vua ~.Vl~lrvlvlJlvt~ %Wt. RS CAS# 100.00 Nitrogen No 7727379 I1HL~KKL H. 7.7P1.7.711P~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -21- 07/12/2007 F MERCY HOSPITAL ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME DICHLORODIFLOROMETHANE Location within this Facility Unit BOILER RM SiteID: 015-021-000628 ~ Facility Unit: MAIN BLDG 1ST FLOOR ~ Days On Site 365 Map: Grid: CAS# 75-71-8 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas_ ~Mixtur~Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 35.00 FT3 635.00 FT3 317.00 FT3 rlr~~ru<LVUS ~ulnrvlv~iv_15 oWt. RS CAS# 100.00 Dichlorodifluoromethane No 75718 t1AGHtC1J H55~ 751~1t51V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -22- 07/12/2007 F MERCY HOSPITAL ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME XENON, XE 133 GAS Location within this Facility Unit HOT LAB NUCLEAR MEDICINE SiteID: 015-021-000628 ~ Facility Unit: MAIN BLDG 2ND FLOOR ~ Days On Site 365 Map: Grid: CAS# 7440633 ~GasATE TPureE ~-AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 250.00 FT3 250.00 FT3 125.00 FT3 tu~~tirclivu~ ~vi~irulv~lv~l~~ %Wt. RS CAS# 100.00 Xenon No 7440633 riAGH.ttL E155~551~lL1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -23- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0001 Facility Unit: WEST TOWER 1ST FLOOR ~ COMMON NAME / CHEMICAL NAME SUN GLOH Days On Site 365 Location within this Facility Unit Map: Grid: DIETARY CLEANING SUPPLY CAS# Liquid TMixture ~ Ambient~E ~ AmbientT~E ~PLASTICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 48.00 GAL 24.00 GAL HAZARDOUS COMPONENTS - ~ , $Wt. RSA CAS# HAZARD AS SESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UnR -24- 07/12/2007 F MERCY HOSPITAL ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME OXYGEN Location within this Facility Unit NURSES STATION SUPPLY RM SiteID: 015-021-000628 ~ Facility Unit: WEST TOWER 2ND FLOOR ~ Days On Site 365 Map: Grid: CAS# 7782-44-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas TPure ~~Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION - Largest Container Daily Maximum I Daily Average 23.00 FT3 46.00, FT3 23.00 FT3 t1t~Y,flttLV UJ w1~1ru1vL' lv 15 sWt. RS CAS# 100.00 Oxygen, Compressed No 7782447 tira~xtcL r~~5~aain~ivl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -25- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0001 Facility Unit: WEST TOWER 3RD FLOOR ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: SUPPLY RM BY NURSING STA CAS# 7782-44-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE = Gas TPure -Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 23.00 FT3 12.00 FT3 Y1E~GLiKLVUa 1..V1~lYV1Vt51V 1 J ~Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 t1E'~GHKL E~.7J1;JJ1~1L'1V1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -26- 07/12/2007 F MERCY HOSPITAL ~ Inventory Item 0001 ~ COMMON NAME / CHEMICAL NAME I OXYGEN Location within this Facility Unit EQUIP RM W HALL SiteID: 015-021-000628 ~ Facility Unit: WEST TOWER 4TH FLOOR ~ Days On Site 365 Map: Grid: CAS# 7782-44-7 ~GasATE TPureE ~AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Con23100rFT3 Daily M92100m FT3 ~ Daily A41r00e FT3 t11~GH.ttLVUS w1~lr~lvl~;1v17 %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 riAGa'~L[L A~~I;5~1~1L1V'15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -27- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0001 Facility Unit: WEST TOWER 5TH FLOOR ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: NURSES STATION SUPPLY RM CAS# 7782-44-7 ~Ga.SATE ~ TYPE I AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER Pure AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 23.00 FT3 23.00 FT3 12.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 tll-~GHtCL t1J J L' J 51~1~1V 15 TSecret RS BioHaz RadioactivejAmount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -28- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0009 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ COMMON NAME / CHEMICAL NAME HYDROGEN/CARBON DIOXIDE/NITROGEN Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM N SIDE HALL CAS# ~GasATE TMixtur~AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average FT3 100.00 FT3 50.00 FT3 riHGE~tCLVUS 1:V1~lYV1V151V 1 SWt. RS CAS# 4.70 Hydrogen Yes 1333740 10.30 Carbon Dioxide No 124389 84.90 Nitrogen No 7727379 t1HGH.tC1J E~55L' ~~1~11;1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Ext ~ Inventory Item 0013 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ COMMON NAME / CHEMICAL NAME NITROUS OXIDE Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM N SIDE HALL CAS# 10024-97-2 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 200.00 FT3 100.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Nitrous Oxide No 10024972 tiEiG.'iL[L .'~5 a 1~, ~ 71~1tSly 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi -29- 07/12/2007 F MERCY HOSPITAL SitelD: 015-021-000628 ~ ~ Inventory Item 0005 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ COMMON NAME / CHEMICAL NAME ALCOHOL Days On Site 365 Location within this Facility Unit Map: Grid: PURCHASING WHSE C CAS# 67-63-0 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient PLASTIC CONTAINER ~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average i GAL 48.00 GAL 24.00 GAL tu~~r-~t<.l~vu~ trul~iruiVrlV1~ %Wt. RS CAS# 70.00 Isopropyl Alcohol No 67630 t11~Gt1KL L-15a~a~1~1~1V1a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod ~ Inventory Item 0004 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ COMMON NAME / CHEMICAL NAME ALCOHOL Days On Site 365 Location within this Facility Unit Map: Grid: PURCHASING WHSE C CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~mbient ~mbient ~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average GAL 32.00 GAL 16.00 GAL nl-1GtitCL V U.7 1. V lilt' ulV P~1V 1 S %Wt. RS CAS# 99.00 Isopropyl Alcohol No 67630 !11'iGE1CCL H SJL~.7J1~1J,,1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod -30- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0012 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ COMMON NAME / CHEMICAL NAME COMPRESSED AIR 250CF Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM N SIDE HALL CAS# 0 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE = Gas TPure l~Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 2000.00 FT3 1000.00 FT3 nt~~r~cl~vu~ ~VriYV1Vn1V 1 a %Wt. RS CAS# 100.00 Air No 0 nr~~.ylclJ r~5~~aal~irJlvl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min ~ Inventory Item 0007 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ COMMON NAME / CHEMICAL NAME HELIUM NON-FLAMMABLE Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM N SIDE HALL CAS# 7440-59-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest ContainerFT3 Daily1250100m FT3 I Daily 625r00e FT3 riEiL+titCL V U.7 1. V 1~1Y V1V iS1V 1 J %Wt. RS CAS# 100.00 Helium No 7440597 !31'iGri[CL ti~ JJP~.7J1"1rJ1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH / / / Min -31- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0008 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ COMMON NAME / CHEMICAL NAME NITROGEN NON-FLAMMABLE Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM N SIDE HALL CAS# 7727-37-9 ~SolidE I PureE ~~~ PRESSURE TEMPERATURE CONTAINER TYPE I Ambient ~ Ambient OTHER - SPECIFY AMOUNTS AT THIS LOCATIONff Largest ContainerLBS Daily 500100m LBS I Daily 250r00e LBS ri1~,LKtCLVU~ ~.~i~lrvlv~lV 1S %Wt. RS CAS# 100.00 Nitrogen No 7727379 ri1~[,EiKL Lj~7 ~71".i J J1~1L" 1V 1 ~.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH / / / Min ~ Inventory Item 0011 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ COMMON NAME / CHEMICAL NAME COMPRESSED GAS NON-FLAMMABLE 250CF Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM N SIDE HALL CAS# 0 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TPure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 1500.00 FT3 750.00 FT3 HAZARDOUS COMPONENTS %Wt. RSI CAS# HAGrircl, Lj7 7~.7~1~1~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH / / / UnR -32- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0004 Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ~ COMMON NAME / CHEMICAL NAME CO2/H2/N2 Days On Site 365 Location within this Facility Unit Map: Grid: LAB-MAIN CAS# ~GasATE ~Mixtur~-AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 239.00 FT3 209.00 FT3 104.00 FT3 t11-~GHKLUU~ COMPONENTS %Wt. RS CAS# 5.00 Carbon Dioxide No 124389 10.00 Hydrogen Yes 1333740 80.00 Nitrogen No 7727379 ri1~GHtCL H. 7DL" .7.71~1tS1V 1 ~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Ext ~ Inventory Item 0005 Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ~ COMMON NAME / CHEMICAL NAME CO2/N2 Days On Site 365 Location within this Facility Unit Map: Grid: LAB-MAIN CAS# ~GasATE Mixture I-AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Co239100rFT3 Daily 209100m FT3 I Daily 104r00e FT3 riHGHtCLVU.7 1.V1~lYUlVt',1V 1.7 %Wt. RS CAS# 10.00 Carbon Dioxide No 124389 90.00 Nitrogen No 7727379 ri(-~GHiCL H5 J1=,~J1~1tS1V 1.7 TSecret RS BioHaz RadioactivejAmount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -33- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0001 Facility Unit: TREATMENT/DIAGNOSTIC 4TH FLO ~ O A C MMON NAME / C CHEMI AL N ME NITROUS OXIDE Days On Site 365 i i i i i id Location w thin th s Fac l ty t Map: Un Gr : STORAGE RM CAS# 10024-97-2 STATE T TYPE ~GaS I Pure T PRESSURE TEMPERATURE I Above Ambient Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 56.00 LBS 700.00 LBS 350.0.0 LBS tiHL,Lj.1CLVU.~ 1:V1~lYV1V~1V1J gWt. RS CAS# 100.00 Nitrous Oxide No 10024972 rlt~~.xtcl~ xJJnJJI~il;lvla TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0002 Facility Unit: TREATMENT/DIAGNOSTIC 4TH FLO ~ COMMON NAME / CHEMICAL NAME OXYGEN COMPRESSED Days On Site 365 Location within this Facility Unit Map: Grid: THROUGHOUT SURGERY AREA CAS# 7782-44-7 ~GasATE TPureE ~-AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 23.00 FT3 23.00 FT3 23.00 FT3 riliGHttLVUJ 1.:V1~lYV1VL'1Vlb %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 l1tiGH.CCL H~ Jw7P~J.71~1P~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -34- 07/12/2007 F MERCY HOSPITAL ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME ALCOHOL, ISOPROPYL Location within this Facility Unit N WALL COUNTER & CLOSET STATE TYPE PRESSURE Liquid TMixture ~ Ambient SiteID: 015-021-000628 ~ Facility Unit: CARDIAC REHAB CENTER ~ Days On Site 365 Map: Grid: CAS# 67-63-0 TEMPERATURE CONTAINER TYPE Ambient -~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 1.00 GAL 0.50 GAL tit~~rjtt~vu5 ~vi~irul~~iv"1"a %Wt. RS CAS# 70.00 Isopropyl Alcohol No 67630 riAGKKL A5,5Li,,J~1~11'~1V"1"5 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod -35- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0005 Facility Unit: MRI ~ COMMON NAME / CHEMICAL NAME PHOTOGRAPHIC FIXERS Days On Site 365 Location within this Facility Unit Map: Grid: X-RAY DEVELOPER MACHINES, CANCER CENTER, NUCLEAR MED, CAS# SPECIAL DK RM, SURGERY DK RM, MAMOGRAPHY 64-19-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~mbient ~ Ambient OTHER - SPECIFY AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 30.00 GAL 239._0.0 GAL 333.00 GAL 171iGriRLVVw7 L.VITIYVIV L'1V1J %Wt• RS CAS# 46.00 Ammonium Thiosulfate No 7783188 2.00 1,2-Butylene Oxide No 106887 5.00 Acetic Acid Solution No 64196 nraaru~L r1~ ~~a~1Tl~ivta TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Mod ~ Inventory Item 0002 Facility Unit: MRI ~ COMMON NAME / CHEMICAL NAME HELIUM Days On Site 365 Location within this Facility Unit Map: Grid: MRI UNIT TRUXTUN & A ST & EXT GATED AREA CAS# 7440-59-7 ~GasATE ~PureE -~AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 22407.00 FT3 22407.00 FT3 22407.00 FT3 ritaurucLVV.7 L. V1•lt'V1V.G1VtJ %Wt. RS CAS# 100.00 Helium No 7440597 TTT ATTlT1 T AlTT1PT ATRT~.T.n~ TSecret RS BioHaz ilri[~tiLCL Ya~ Radioactive/Amount w7 L' AJ1~1L' 1V 1.7 EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH DH / / / Min -36- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0001 Facility Unit: MRI ~ COMMON NAME / CHEMICAL NAME NITROGEN Days On Site 365 Location within this Facility Unit Map: Grid: MRI UNIT TRUXTUN & A ST & EXT GATED AREA CAS# 7782-37-9 ~GasATE ~pureE -~AboveSAmbEent AmbientT~E PORTCOPRESSER CYLINDER AMOUNTS AT THIS LOCATION Largest C3930100rFT3 Daily6312100m FT3 I Daily9468r00e FT3 tita~xtclivu~ ~uinruiv~iv~1~5 sWt. RS CAS# 100.00 Nitrogen No 7727379 ttAY,i-1ttL r~a~~~~rl~lvla TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P R IH / / / Min -37- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 03/24/2000 ~ CALL 911. Employee Notif./Evacuation 10/20/1992 NOTIFICATION AND EVACUATION PROCEDURES IN ALL UNITS INITIATED BY FIRE ALARM SYSTEMS AND OVERHEAD PAGING SYSTEM. AREAS NOT REACHED BY OVERHEAD PAGING ARE NOTIFIED OF ALL ALERTS VIA LAND OR MESSENGER FROM COMMAND CENTER IN EVENT OF INTERNAL DISASTER DECLARATION. Public Notif./Evacuation REPORTED THROUGH EMERGENCY MEDICAL SERVICES (KERN COUNTY). 10/20/1992 Emergency Medical Plan MERCY HOSPITAL EMERGENCY DEPT. 03/24/2000 -38- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 07/24/2006 ~ ONGOING FIRE SAFETY PROGRAM FOR ENTIRE FACILITY, WHICH INCLUDES MONTHLY FIRE DRILLS - FIRE EXTINGUISHER INSPECTIONS, MONTHLY INSPECTIONS OF FIRE SPRINKLERS AND STANDPIPES. INSPECTIONS FOR OPERATIONS OF ALL FIRE AND SMOKE BARRIER DOORS. PREVENTIVE MAINTENANCE ON ALL FIRE PROTECTION RELATED EQUIPMENT. FIRE PLANS, DISASTER PLANS, ETC AVAILABLE 24 HOURS TO ALL EMPLOYEES. HOUSEKEEPING AGENTS ISOLATED IN DESIGNATED ROOM, EXCEPT FOR SMALL AMOUNTS USED BY PERSONNEL IN HOUSEKEEPING DUTIES. PAINTS AND FLAMMABLES KEPT IN SAFETY STORAGE CABINET LOCKER IN PAINT SHOP. FORMALIN KEPT IN SPECIAL CONTAINERS IN AMBULATORY SERVICES. SPILL KIT AVAILABLE FOR CONTROL OF SPILLS. INFECTIOUS WASTE CONTAINED IN UTILITY CLOSET, PICKED UP DAILY, Release Containment 07/24/2006 SPILL KITS AVAILABLE IN ALL HOUSEKEEPING CLOSETS. SPILL KITS AVAILABLE THROUGHOUT LABORATORY. SPILL KITS AVAILABLE IN RADIOLOGY DEPT. VERMICULITE AVAILABLE IN SECURITY VEHICLE. VERMICULITE AND OTHER ABSORBING PRODUCTS AVAILABLE IN ENGINEERING DEPT. Clean Up 07/24/2006 MINOR SPILLS CLEANED UP BY HOUSEKEEPING SERVICES FOR CLEAN UP CONTRACTED WITH CALPI INC. MINOR CLEAN-UP BY INDIVIDUAL DEPARTMENTS. CLEAN-UP AND DISPOSAL SERVICES BY SIERRA MEDICAL SERVICES FOR RADIOLOGY AREAS. -39- 07/12/2007 F MERCY HOSPITAL SiteID: 015-021-000628 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Other Resource Activation 11/30/1998 AIR MONITORING BY CLEAN-UP CONTRACTOR. AIR MONITORING SERVICES BY COHR ENGINEERING SERVICES. AIR MONITORING SERVICES BY CTL ENVIRONMENTAL SERVICES. WASTE DISPOSAL BY CONTRACT BFI INC. -40- 07/12/2007 _,, P MERCY HOSPITAL SiteID: 015-021-000628 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~ Special Hazards 03/24/2000 ~ RADIOISATOPES ON HAND RADIATION HAZARD. Utility Shut-Offs 05/17/2007 GAS - S WALL EXT BOILER RM ELECTRICAL - S WALL INT BOILER RM WATER - S OF S EXT WALL ADJ TO BOILER RM Fire ProteC./Avail. Water 02/05/2007 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS, W TOWER AND TREATMENT DIAGNOSTIC BLDG HAS SPRINKLERS, MAIN BLDG PARTIALLY SPRINKLERED. DRY STANDPIPES IN MAIN BLDG AND W TOWER AND TREATMENT/DIAGNOSTIC BLDGS, AND WET STANDPIPES IN SKILLED NURSING FACILITY. FIRE HYDRANT - SURROUND ENTIRE FACILITY. FIRE DEPT CONNECTIONS ON S WALL ON ER RAMP FOR WEST TOWER FD. FDC FOR MAIN BLDG NEAR OLD MAIN ENTR TO HOSPITAL AT TRUXTUN AVE. FDC FOR BUSINESS OFFICE ON ST PARKING LOT ENTR. FIRE DEPT SPRINKLER CONNECTION FOR NEW ENTRY AND CLEROU CONFERENCE ROOMS ON 16TH ST ON CRNR OF BOILER RM BLDG NEXT TO SERVICE ENTR BY TRASH COMPACTOR. Building Occupancy Level 03/31/2006 1000 EMPLOYEES -41- 07/12/2007 d at o F MERCY HOSPITAL SiteID: 015-021-000628 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 07/24/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: EACH EMPLOYEE TAUGHT TO USE MSDS AND SAFETY. ALL EMPLOYEES REQUIRED TO ATTEND GENERAL ORIENTATION WHICH COVERS FIRE SAFETY, HAZARD COMMUNICATIONS, GENERAL SAFETY AND MSDS. ALL EMPLOYEES ATTEND DEPT ORIENTATION. ALL EMPLOYEES REQUIRED TO ATTEND ANNUAL EDUCATION DAY (8 HRS). ruyc ~ noa.u ivi ru~.uic u5C nclu iuL ruLU1.C use -42- 07/12/2007 i= UNDERGROUND STORAGE TANKS ~" ,~. -.uitY6:Ki V'L.W~'+r:nt/W:KHRW\icw 1F14L4fN:Y:uM'XGIWYTIfPV.A.Y~KU1'~:.b~rxrYf/NMV:IfLCAWCIr:.~'. [~~~ APPLICATION ~- TO PERFORM ELD 1 LINE TESTING ?`s 1 SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. ^ ENHANCED LEAK DETECTION ^ TANK TIGHTNESS TEST ^ LINE TESTING TO PERFORM FUEL MONITORING CERTIFICATION SITE INFORMATION BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ SB-989 SECONDARY CONTAINMENT TESTING FACILITY G + O J (~Ih ` NAM & PHO y E NUMBER OF''CnnONTACT PnnE'RnSON (^ ''~~ ~' ~1L.5 lj~ ~ ~Y'~ ~ ADDRESS ,/~ ~ ~/ ~ (, ~~ ~ ~~ ~~ OWNERS NAME I~ OPERATORS NAME PERMQi~PEtRATE NO~~Q~~.7 \~~ ' ~W (~ - --~ NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? ^ YES ^ NO _ __~ TANK # V LUME O CONTENTS ___ // 11 ... - -- ` . , ,. - } ~ ~ -- ~ i -- --- - - -' . ----- - _ --- I _ I _ __ _ ~ TANK TESTING COMPANY __ NAME TESTING ~,QMPAN~ ` ME & P ONE NUMBER OF ONTACT~ PERSON ~~~ I MAILING ADDRESS ~c.~~-~^\~'~, 1~~ ~~ N E & P~iONE NUMB R O T TER O~~R SPECIAL INSPECTOR ~~~~~~~~ `A \ \ ~~~~ CERTIFICATION #: '4 lW: __ ___~ DATE &,]'I~E TES ~O,@E CO DUCTED ICC #; ^ TEST METHOD ~, ~GNATURE OF APPLIC DATE ~ _ j EN A~4Y~~~--- ~ 1. APPROVED BY ~-- __ DATE f/R/ ARTY f FD 7.095 (Rev. 09/05) FROM :BSSR,INC FAX N0. :66158$2786 Nov. 06 2006 03:06PM P1 ~~ ' UNDERGROUND STORAGE TANK5 ~ ~A~ETZ$~`IELD FIRE DEP'T`. $ P pieV~P1~lOII S@TV'iC@S h b AR7'AM f 900 Truxtun Avr.., Ste. 2111 APPLICATION Bakersf~lCi, CA 93:301 Tp PEF21=t3RM ELO! LINE TESTING Tel.: (fib 1) 326-3470 / 58989 SECONDARY CONTAINMENT TESTING FcZ7c: (C]C] 1) $S:2-;? L71 !TANK RIGHTNESS TESTAND TO PERFORM FUEL MONITORING CERTlF1CAT10N ~ 1 oI I PE RMff Np ~~ ~~~ , . © ENNANCEO LEAK DETECTION ^ LINE TESTI NG ^ SS•989 SECUNpARY (;ON7AUVMENT'(ES~'INw _^ TANK TIGhiTNESS TE57 ~ TO PF.RFQRM FUEL MONITORING CF,RTIFI4ATIpN _~-_____. _ _ _ ,,. SITE INFORN1AT10N ,_„___„ _, , , .__....__...._....... ... _ ~SACT~~~ FACILITY • NAME 8 Pt{O E NN~1tl8ER `~ ~ ! J ^ . ADDRESS ~~ ~~~`~~ ' ' - . _.. _. _ ~ OWNEtiS NRME , OPERATORS NAM$ ~ PERMIj Tr~PE_ IiQT€~NOs,~,,,~ ~~~ NUIvtB£R OF TANKS TO BE TESTED S,,,~IPlNG GDING TO SE TESTED? O Y„€S „,,,,.,_.._Q Nc __.________,_______..,, .. _ , NAME 7E 71NG MPAN ~j~ .~~nn MA~~~D3~V ~A1L E & P~IONE NUM R O T TER OR SPEG~4l, IIV$P C' DAT ry~$T Tp E CO DUCTE^ SIGNATLERE OF APPLIC ~ C l~ TANK TESTING COMPANY ~~~ NAME $ Ph _ APPROVED BY ® ~~ / ~~,~//l~'^> __.."T ~~ ~ ~ ~~~ CERTIi"ICATION d: ~`-"113! DATE DATE OF ONTACTP RSON j TEST MtTFiOD .~~__..FD 200!i iRev. 09/05; -. INSPECTIONS BUSINESS PLAN & INVENTORY PROGRAM - UNIFIED PROGRAM INSPECTION CHECKLIST B E R S F I L D F/BE ARTM T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 FACILITY NAME: ~~c ~~`,n~ INSPECTION DATE: ~~ - f Section 2: Underground Storage Tanks Program ^ Routine /Combined /~^ Joint Agency ^ Multi-Agency ^ Complaint ^ Re-Inspection ~/,~ Type of Tank I,~(L~ ~-g Number of Tanks ~ _ v Type of Monitoring ~I.GN Type of Piping ~ ~/n ~"-~ OPERATION C V COMMENTS Proper tank data on file Ov Proper owner /operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? ^ Yes o Section 3: Aboveground Storage Tanks Program Tank Size(s) Type of Tank Aggregate Capacity Number of Tanks ~~ t ~~~ OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF?) If yes, does tank have overfill !overspill protection? C =Compliance V =Violation Y =Yes N = No Inspector: Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services Pink -Business Copy K8F-)335 FD 2156 (Rev. 09/05) ~~~ ~~- u ..: + MERCY HOSPITAL ______________________________________ SiteID: 015-02.1-000628 + Manager p ~ ~C~ic~~t Location: 2215 TRUXTUN AVE City BAKERSFIELD CommCode: BFD STA Ol EPA Numb: CAD981400237 Bus Phone : -`-`tom-o l i ,-'" ~ "' Map 102 CommHaz Extreme Grid: 25D FacUnits: 34 AOV: SIC Code:8062 DunnBrad:95-166-0858 Emergency Co t~ac~g Title~~'~ ~'~"mergency Contact / Title~~d ~~~~~A6i~~ KEN STONECIPHER / FACILITY ~T3'~' Business Phone: (661) 63.2-~~-~~- ~ Business Phorie: (661) 632z5872x 24-Hour Phone (661) 632-5000x 24-Hour Phone (661) 632-5000x Pager Phone $6' '' ~' °'~ Pager Phone ( 6 61) 3 3 7 -1914 x Hazmat Hazards:. RSs Fire Press React ImmHlth DelHlth Contact I~;,~1v ~rr~u~' Phone : ( 661) ~ MailAddr: 2215 TRUXTUN AVE State: CA City BAKERSFIELD Zip 93301 + - - - - - - - - - - - - - - - - - - - - - - - - Si[r --------------------------------------- - .~,,~'t~-----+ Owner CATHOLIC HEALTHCARE WEST Phone: ¢415) - ~,.,,, enrTmrnrR~av gym- ~ ~~ `~ p S ~ State • CA Address = s erg-~a+d~ei-rvvr:aie x-ar-~ v ®/ D City SAN FRANCISCO `,~L-3dZ3 Zip 94111 Period. to ~ TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: Yes ParcelNo• Emergency Directives: ~`~ `~ ~,~ J ENr~ ~~~ ~ 4 2 PROG A - HAZMAT oo~ PROG C - COMM-HOOD PROG H - HAZ WASTE GEN PROG U - UST THIS SITE CONTAINS UNDERGROUND .STORAGE TANKS AND IS A WASTE TREATMENT SITE! JOINT INSPECTIONS WITH PREVENTION SERVICES AND THE ENGINE COMPANY ARE REQUIRED. PLEASE CALL THIS OFFICE AT LEAST 5 DAY PRIOR TO SCHEDULING THIS INSPECTION. Based on my inquiry of those indivi~t4a~is responsible for obtaining the ihformation, I certify under penalty of law that ! have p~r~cnally examined and am familiar with the ir~iormation submitted an~,~jlieve the infnrmatiori is true, ~csai'ate, andt o plet~ > /~/~~ ~~~ ~~~ ~~ppl -1- 03/31/2006 FROM :BSSR,INC ~ ~, . ,, FAX N0. :66158~2r86 .Tun. 12 2006 02:42PM P2 ' ~ • 5ECQ~A,~Y SYS~M CTg'ICA~"i'ION FOB ~~~ Turbine Snmp~ ~. •.J t3, ti E'S ~ L - ~ . Sump 1 ~ Sump ~ $utnp 3 Sump ~ Start Vane ~ o O G Initis~ Hex ~ . I ~j ~ ~ of Wader Time ~ Ct '. 1 l way $e~~ G . ~ 3~ ~ ~t:tiG Water ~eigbt (~j ~. 13 a b ~ . Time ~ ~ 1 '4Vatear fight (~ , 1 '~ ©~ C~rtiYicattan '~GI~-.~t~ .~1~1-~' . 4v~1 ~ack~a . i~ c ~ 5 ~ ~- 4verl~ilE 1 Uvci~112 C?~vertiii 3 Opera 4 Start T~atie ~ ~ : ~ ~ i ~~ y3 0 z 5 '~ r y a . 7~Yme '~ : ~S ~ water weight ~ ~ . ~ a ~ ~, ~;KO . Water gist ~ ,'3 U ! $,• Certi~iicattor~ ~~ ~ (S~a) ,. P ~ ~~ ..w -- FROM :BSSR,INC Jun. 12 2006 02:43PM P3 E. ~,i .,Ai3 ^,777 ^I IM6 L ;a l! ..! -S ~ iF n(~~iT Ti?:l~'TL'F~ SLir1P B~SR T~.'=Ttr; Tr•: ,•'+•AC~TS-r~ tt<r,},. AtS t}i,_`l `i ._'~7? TEST ~TARTLfI 9°~f 1.`a11E~06 ~ : 41~ R^, E'ND TTP1E '9'25. AM -r.Jr) `}~iT>- ~~,.~~~»r~g~ ';i.Jft~y ~::~1K. '''8T ~,E~'OR.T E~~ !,F~~4- , Fi, 1 ~(~~ Y~ TF.,T RFSLI~..T °ASSF'0 FAX N0. :661582786 T. RUk;TLS! R°~S¢ TCSTrp ',-S-. '~'''r"-!R ; rte ry, 25 i^} i'~iTP!RTE[Y TF:::z- @5/Y6r`2~7t5 y :. EN!} tIFiE 7:4~! r~M T~~'? FtES~~1 ~R~~~F.G~ UNDERGROUND STORAGE TANK :;. ;~--P~RMIT APPLICATION TOCONSTRUCT-INSTALL NEW TANK (NEW FACILITY) / NEW TANK INSTALLATION (EXISTING FACILITY) I MODIFICATION / & MINOR MODIFICATION -FACILITY ,w/R/ ARTM T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 PERMIT NO. h,~ O ~ O ~ ~ f Page 1 of 1 TYPE OF APPLICATION: ^ NJEW TANK INSTALL /NEW FACILITY ^ NEW TANK INSTALLATION /EXISTING FACILITY:~~ `>: (!:hack nna ifam nnlvl r `~MOI~IFICATInN (7F FACII ITV fl MIN(7R MnDIFICATInN~OF FACILITY TARTING DATE ~ ' ~ O R~ ~ i ~ COMPLETION DATE AV AGILITY NAME 1 ` ~ ISTING FACILITY PERMIT N ~ Q ~, ~ ~ ~ ~~ .iC-O AGILITY ADDRESS L? Q ,~ / / / N ~ ITY _ ~ ~ ~ ~~~ ~~ ~ ~ , IP CqODEL~n.-,'`~ I / Jl./ PE OF BUSINESS N #', JS /~ '~-_ ANK OWNER ~t2 ~ of ` ~. ~~~ ~ NONE NO ~~z-- ~ `JAI DRESS ITY - IP CODE ONTRACTOR A LICENSE N0. CC N0. DRE S ITl' / ~ IR CODE :~ ~ V L~ ~ .Q' ~~C ~~~ ~ ~,7 HONE N0. RSFIELD CITY BUSIN S LICENSE N0: ORKMANS COMP N N RER ~~ RIEFL DESCRIBE THE WORK TO BE DONE ! ~ J c~ c~~ - .---~ - ~ ,. I ~y :7 ~ ) / ' WATER TO FACILfTY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE NO. OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ' ^ YES ^ NO ^ YES ^ NO THIS SECTION IS FOR MOTOR FUEL TANK NO. OCUME NLEADED GULAR REMIUtvi" IESEL" VIATION THIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. OLUME NLEADED GULAK - REMIUM IESEL '' ., VIATION FOR OFFICIAL USE ONLY APPLICATION DATE. FACILITY No Nn nG rnukc cccc c The applicant has received, wtdersumds; and will comply with the attached conditions of the permit and arty other state, local and federal regulations. This form has been completed under peralty of perjury, and to the best of my Imowledge, is true and correct. ~N ~ ist~7~~: ~trJ /y1~~ GC.tI ` APPLICANT NAME (PRINT) APPLICANT SIGNATURE APPLICATION BECOMES A PERMIT WHEN APPROVED FD2086 IR.~.o>uosl u ~~ ~~ MERCY HOSPITAL SiteID: 015-021-000628 Manager KEVIN KLOCKENERA Location: 2215 TRUXTUN AVE City BAKERSFIELD BusPhone: (661) 632-5503 Map 102 CommHaz High Grid: 25D FacUnits: 34 AOV: CommCode: BFD STA Ol EPA Numb: CAD981400237 SIC Code:8062 DunnBrad:95-166-0858 Emergency Contact / Title Emergency Contact / Title KEN LABRECQUE / ADMIN DIRECTOR KEN STONECIPHER / FACILITY DIR Business Phone: (661) 632-5642x Business Phone: (661) 632-5872x 24-Hour Phone (661) 632-5000x 24-Hour Phone (661) 632-5000x Pager Phone ( ) - x Pager Phone (661) 337-1914x Hazmat Hazards: RSs Fire Press React ImmHlth DelHlth Contact KEN LABRECQUE Phone: (661) 632-5642x MailAddr: 2215 TRUXTUN AVE State: CA City BAKERSFIELD Zip 93301 Owner CATHOLIC HEALTHCARE WEST Phone: (415) 438-5550x Address 185 BERRY ST 300 State: CA City SAN FRANCISCO Zip 94107 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: Yes ParcelNo: Emergency Directives: PROG A - HAZMAT PROG C COMM HOOD ` = PROG H - HAZ WASTE GEN PROG U US o O\` T id l ENT ~ AY ~ 7 ua s €.~:ed s5n my inquiry of those indiv 2007 respcnsl~;r~ fef c~bt;~ining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe she information is true, c rate, and complete. f~'T Signature ~ Date -1- 05/03/2007 F MERCY HOSPITAL Last Action Type: SiteID: 015-021-000628 ~ STORAGE CONTAINER DATA (UST FORM A) FACILITY/SITE INFORMATION Business Name: MERCY HOSPITAL Cross Street Business Type: Org Type: Total Tanks IndnRes/Trust: No PA Contact: Dsg Own/Oper BRETT A. TACKET ICC Nbr: 5243805-UC PROPERTY OWNER INFORMATION Name KEN STONECIPHER Phone: (661) 632-5872x Address: City State: Zip: Type TAN F N Name KEN STONECIPHER Address: City Type BOE UST Fee# Financ'1 Resp: Legal Notif Date: Name: State UST ## K OWNER IN ORMATIO Phone: (661) 632-5872x State: Zip: Phone: ( ) Ttl: 1998 Upg Cert#.: x -2- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order EXTERIOR CAMPUS ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP KATHON LM F IH L 30.00 GAL Mod DIESEL F IH DH L 8000.00 GAL Low OXYGEN F P IH G 3600.00 FT3 Low WASTE OIL F DH L 55.00 GAL Low -3- 05/03/2007 J 7 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order MAIN BLDG 1ST FLOOR ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP ACETYLENE 130 E F P IH G 1300.00 FT3 Hi ALCOHOL IH L 10.00 GAL Mod OXYGEN 281 F P IH G 5620.00 FT3 Low CHLORODIFLOUROMETHANE F P IH G 1116.00 FT3 Low CARBON DIOXIDE USP, OXYGEN USP F P IH G 425.00 GAL Low NITROGEN 304 F P IH G 6080.00 FT3 Min DICHLORODIFLOROMETHANE F P IH G 635.00 FT3 Min -4- 05/03/2007 i- F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order MAIN BLDG 2ND FLOOR ~. Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP XENON, XE 133 GAS F P IH G 250.00 FT3 Min -5- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order WEST TOWER 1ST FLOOR ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP SUN GLOH L 48.00 GAL UnR -6- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order WEST TOWER 2ND FLOOR ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F P IH G 46.00 FT3 Low -7- 05/03/2007 ~, F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order WEST TOWER 3RD FLOOR ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F P IH G 23.00 FT3 Low -8- 05/03f2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order WEST TOWER 4TH FLOOR ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F P IH G 92.00 FT3 Low -9- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order WEST TOWER 5TH FLOOR ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F P IH G 23.00 FT3 Low -10- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order TREATMENT/DIAGNOSTIC 1ST FLO ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP HYDROGEN/CARBON DIOXIDE/NITROGE E F P IH G 100.00 FT3 Ext NITROUS OXIDE F P IH G 200.00 FT3 Hi ALCOHOL DH L 48.00 GAL Mod ALCOHOL DH L 32.00 GAL Mod COMPRESSED AIR 250CF F P IH G 2000.00 FT3 Min HELIUM NON-FLANIMABLE P IH G 1250.00 FT3 Min NITROGEN NON-FLAMMABLE P IH S 500.00 LBS Min COMPRESSED GAS NON-FLAMMABLE 25 P IH G 1500.00 FT3 UnR -11- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order TREATMENT/DIAGNOSTIC 2ND FLO ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP CO2/H2/N2 CO2/N2 E F P F P IH IH G G 209.00 209.00 FT3 FT3 Ext Min -12- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order TREATMENT/DIAGNOSTIC 4TH FLO ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP NITROUS OXIDE OXYGEN COMPRESSED F P F P IH IH G G 700.00 23.00 LBS Hi FT3 ,Low -13- 05/03/2007 P MERCY HOSPITAL ~ Hazmat Inventory = ~ MCP+DailyMax Order SiteID: 015-021-000628 ~ By Facility Unit ~ = CARDIAC REHAB CENTER ~ __ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP ALCOHOL, ISOPROPYL DH L 1. 0 0 GAL Mod. I -14- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order MRI ~ Hazmat Common Name... ISpecHazIEPA Hazards) Frm I DailyMax IUnitIMCPI PHOTOGRAPHIC FIXERS R IH L 239.00 GAL Mod HELIUM F P IH DH G 22407.00 FT3 Min NITROGEN P R IH G 6312.00 FT3 Min -15- 05/03/2007 -16- 05/03/2007 ME Y H PITA ID Sit 015-021-000628 F RC L OS : e ~ 3 ilit U it F ~ EXTERIOR CAMPUS ~ Inventory Item 000 n : ac y i ~ COMMON NAME / CHEMICAL NAME KATHON LM Days On Site MICROBIOCIDE 365 i i i id n this Fac lity Location with Un t Map: Gr : EXT TO BOILER RM CAS# RE E TY RESS E TEMPERATURE CONTAINER TYPE STAT Liquid T P Mixture P U ~ Ambient ~ Ambient OTHER -.SPECIFY ~ %Wt. RSI CAS# r1E~GHtCL 1-1. 7~1;.7~J1~1P~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / Mod ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME DIESEL Location within this Facility Unit S OF BOILER ROOM STATE TYPE PRESSURE Liquid TMixture ~mbient Facility Unit: EXTERIOR CAMPUS ~ Days On Site 365 Map: Grid: CAS# TEMPERATURE CONTAINER TYPE Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 8000.00 GAL 8000.00 GAL 4000.00 GAL HAZARDOUS COMPONENTS %Wt. ~ RS CAS# 100.00 Fuel Oil No. 1 No 70892103 riHGH1CL L~.7~71;.7.71~11;1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No. No/ Curies F IH DH / / / Low AMOUNTS AT THIS LOCATION Daily Average 30.00 GAL Largest Container Daily Maximum 30.00 GAL 30.00 GAL HAZARDOUS COMPONENTS -17- 05/03/2047 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0001 Facility Unit: EXTERIOR CAMPUS ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: A ST CAS# 7782-44-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TPure -Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest C3600100rFT3 Daily3600100m FT3 I Daily1800r00e FT3 • t1HGHttLVUJ 1,V1~1rvlvt',1v1a oWt. RS CAS# 100.00 Oxygen, Compressed No 7782447 t1AGAttL A~aL~~l~tl;ty 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low ~ Inventory Item 0004 Facility Unit: EXTERIOR CAMPUS ~ COMMON NAME / CHEMICAL NAME WASTE OIL Days On Site 365 Location within this Facility Unit Map: Grid: EXT NEXT TO HW STORAGE CAS# 221 Liquid TWaste ~ Ambient~E ~ AmbientT~E DRUM/BARRELEMETALLI~ AMOUNTS AT THIS LOCATION Largest Con55~00rGAL Daily M55100m GAL. I Daily A50r00e GAL I1HGEiCCLVU~J 1..V1~1rV1VL"1V1.7 %Wt. RS CAS# 100.00 Waste Oil, Petroleum Based No 0 riHGEitCL f>>J ~ 1~, J J 1~1tS1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low -18- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0007 Facility Unit: MAIN BLDG 1ST FLOOR ~ COMMON NAME / CHEMICAL NAME ACETYLENE 130 Days On Site 365 Location within this Facility Unit Map: Grid: BOILER ROOM CAS# 74-86-2 ~GasATE TPureE ~-AboveSAmbient AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 330.00 FT3 1300.00 FT3 650.00 FT3 t1AGHKLVU~ (.:V1~lYV1V151V1'a sWt. RS CAS# 100.00 Acetylene Yes 74862 nt~~t~tcl.~ r~5~~~alnrlvl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0010 COMMON NAME / CHEMICAL NAME ALCOHOL Location within this Facility Unit RESPIRATORY THERAPY Facility Unit: MAIN BLDG 1ST FLOOR ~ Days On Site 365 Map: Grid: CAS# 67-63-0 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture Ambient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 10.00 GAL 5.00 GAL ,r„ ~„ rr..,r,~ ,.,.,,Rr,.,.~r,.,m„ _ __ nt~atucLVUa ~.vitrvtvaivt~ %Wt. RS CAS# 70.00 Isopropyl Alcohol No 67630 nt~c~tjtcL r~~ ~~a~i~i~1V1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / Mod -19- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0006 Facility Unit: MAIN BLDG 1ST FLOOR ~ COMMON NAME / CHEMICAL NAME OXYGEN 281 Days On Site 365 Location within this Facility Unit Map: Grid: BOILER RM CAS# 7782-44-7 ~GaSATE TYPE PRESSURE ~~ TEMPERATURE CONTAINER TYPE TPure Above Ambient I Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 281.00 FT3 5620.00 FT3 2810.00 FT3 YiP,G1-itc1JVU~ C;VLnrVlvl";1v17 ~Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 riHGE~KIJ A~ ~ 1;S SL~LL~1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low ~ Inventory Item 0004 COMMON NAME / CHEMICAL NAME CHLORODIFLOUROMETHANE Location within this Facility Unit BOILER RM Facility Unit: MAIN BLDG 1ST FLOOR ~ Days On Site 365 Map: Grid: CAS# 75-45-6 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Mixtur~Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 1116.00 FT3 558.00 FT3 ritiGHKLVU.~ L,V1~irVlvrlvl.7 %Wt. RS CAS# 100.00 Chlorodifluoromethane No 75456 ns~~.ytcL Ha a~~~l~i~svsa TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / % / Low -20- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0011 Facility Unit: MAIN BLDG 1ST FLOOR ~ COMMON NAME / CHEMICAL NAME CARBON DIOXIDE USP, OXYGEN USP Days On Site 365 Location within this Facility Unit Map: Grid: RESPIRATORY THERAPY CAS# 124-35-9 ~GasATE TYPE ~~ PRESSURE TEMPERATURE ~ CONTAINER TYPE TMixture I Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 425.00 GAL 425.00 GAL 80.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 5.00 Carbon Dioxide No 124389 95.00 Oxygen, Compressed No 7782447 rues-ucL ti~a~aain~lyl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low ~ Inventory Item 0005 Facility Unit: MAIN BLDG 1ST FLOOR ~ COMMON NAME / CHEMICAL NAME NITROGEN 304 Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM IN HALLWAY CAS# 7727-37-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Mixture Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 255.00 FT3 6080.00 FT3 3040.00 FT3 HAZARDOUS COMPONENTS - %Wt. 100.00 Nitrogen RSI CAS# No 7727379 HAZ ARD AS SESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -21- 05/03/2007 F MERCY HOSPITAL ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME DICHLORODIFLOROMETHANE Location within this Facility Unit BOILER RM SiteID: 015-021-000628 ~ Facility Unit: MAIN BLDG 1ST FLOOR ~ Days On Site 365 Map: Grid: CAS# 75-71-8 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas TMixture Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 35.00 FT3 635.00 FT3 317.00 FT3 tiFIGLjKLV UJ ~~inr~iv~iv 1 a oWt. RS CAS# 100.00 Dichlorodifluoromethane No 75718 t1E~GE~ttU E~JJL" JJ1~1~1V 1 ~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -22- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0001 Facility Unit: MAIN BLDG 2ND FLOOR ~ COMMON NAME / CHEMICAL NAME XENON, XE 133 GAS Days On Site 365 Location within this Facility Unit Map: Grid: HOT LAB NUCLEAR MEDICINE CAS# 7440633 = STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas TPure ~-Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 250.00 FT3 250.00 FT3 125.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Xenon No 7440633 tiHGfittL H55~~~1~1i51V 1 7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -23- 05/03/2007 F MERCY HOSPITAL ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME SUN GLOH Location within this Facility Unit DIETARY CLEANING SUPPLY STATE TYPE PRESSURE Liquid TMixture ~ Ambient AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 48.00 GAL 24.00 GAL HAZARDOUS COMPONENTS %Wt. SiteID: 015-021-000628 ~ i Facility Unit: WEST TOWER 1ST FLOOR ~ I Days On Site ' 365 Map: Grid: CAS# i TEMPERATURE CONTAINER TYPE Ambient ~ PLASTIC CONTAINER RS CAS# t1HGKKL A~71;~~1~1iS1V17 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UnR -24- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0001 Facility Unit: WEST TOWER 2ND FLOOR ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 L ti ith i thi ili i M id G oca on w s Fac ty Un n t ap: r : NURSES STATION SUPPLY RM CAS# 7782-44-7 ~GaSATE TYPE TPure T PRESSURE I Above Ambient TEMPERATURE Ambient CONTAINER TYPE PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 23.00 FT3 46.00 FT3 23.00 FT3 nr~~tircLVU~ uvrirvlv~lvla oWt. RS CAS# 100.00 Oxygen, Compressed No 7782447 t1HGKKL E1 aJ~JJl~1L"1V15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -25- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0001 Facility Unit: WEST TOWER 3RD FLOOR ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: SUPPLY RM BY NURSING STA CAS# 7782-44-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TPure -Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 23.00 FT3 12.00 FT3 nt~~tircliv u a ~vl~irviv ~sv s a %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 riE~GAKL A~~L~~1~1~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -26- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0001 Facility Unit: WEST TOWER 4TH FLOOR ~ COMMON NAME / CHEMICAL NAME . OXYGEN Days On Site 365 Location within this Facilit U it M G id y n ap: r : EQUIP RM W HALL CAS# 7782-44-7 STATE T TYPE ~GaS I Pure T PRESSURE ~~ I Above Ambient i TEMPERATURE Ambient ~~ CONTAINER TYPE ~ I PORT. PRESS. CYLINDER I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 23.00 FT3 92.00 FT3 41.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 il[-~G1i.RL ti. 7.7 P~.7 ~71"1r,1V 1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -27- 05/03/2007 F MERCY HOSPITAL ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME OXYGEN Location within this Facility Unit NURSES STATION SUPPLY RM SiteID: 015-021-000628 ~ Facility Unit: WEST TOWER 5TH FLOOR ~ Days On Site 365 Map: Grid: CAS# 7782-44-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas TPure ~-Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Con23100rFT3 Daily M23100m FT3 I Daily A12r00e FT3 • ru3~tixLUU~ ~ui~irulv~lv~l~5 %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 t11~GHKL 1~JJL" JJ1~1L' 1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -28- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0009 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ COMMON NAME / CHEMICAL NAME HYDROGEN/CARBON DIOXIDE/NITROGEN Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM N SIDE HALL CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TMixture Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average FT3 100.00 FT3 50.00 FT3 rlt~c~titcl~vu~ ~.vl~lrvlvnly 1 ~ %Wt. RS CAS# 4.70 Hydrogen Yes 1333740 10.30 Carbon Dioxide No 124389 84.90 Nitrogen No 7727379 tlE~GHttL L~551;A.71~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Ext ~ Inventory Item 0013 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ COMMON NAME / CHEMICAL NAME NITROUS OXIDE Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM N SIDE HALL CAS#k 10024-97-2 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 200.00 FT3 100.00 FT3 HHGHKllUU~ C:UMYUN~N'1'~ %Wt. RS CAS# 100.00 Nitrous Oxide No 10024972 i1HG1itCL tib JL~~JJ1~1~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi -29- 05/03/2007 ~ MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0005 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ COMMON NAME / CHEMICAL NAME ALCOHOL Days On Site 365 Location within this Facility Unit Map: Grid: PURCHASING WHSE C CAS# 67-63-0 Liquid TMixture~ Ambient~E ~ AmbientT~E PLASTICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average GAL 48.00 GAL 24.00 GAL ny,~xrcLUU~ ~.ui~iruiv.c,lvla oWt. RS CAS# 70.00 Isopropyl Alcohol No 67630 t1E~G1-1tCL 1j~~L.~J1~1L'~1V l TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod ~ Inventory Item 0004 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ COMMON NAME / CHEMICAL NAME ALCOHOL Days On Site 365 Location within this Facility Unit Map: Grid: PURCHASING WHSE C CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture~ Ambient ~ Ambient ~STIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average GAL 32.00 GAL 16.00 GAL t'1ti/~littLVU~ ~,vtYlrvtv~lV1J cwt. Rs cAS# 99.00 Isopropyl Alcohol No 67630 I11~GEitCL 1-~ J.7L" .7.71~1L" 1V 1 ~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod -30- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0012 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ COMMON NAME / CHEMICAL NAME COMPRESSED AIR 250CF Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM N SIDE HALL CAS# 0 ~GaSATE TYPE T PRESSURE TEMPERATURE CONTAINER TYPE TPure I Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 2000.00 FT3 1000.00 FT3 ti1~GAttLV U 7 w1~1rv1vLly 1 a °sWt. RS CAS# 100.00 Air No 0 ri1~GEiKL Ha ~J ~ 7 71~1~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min ~ Inventory Item 0007 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ COMMON NAME / CHEMICAL NAME HELIUM NON-FLAMMABLE Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM N SIDE HALL CAS# 7440-59-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas TPure ~-Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 1250.00 FT3 625.00 FT3 I1tiGl~i[LVUw7 1.V1~lYV1VL"1V 1.7 %Wt. RS CAS# 100.00 Helium No 7440597 Llt`iGHKL 1-~, ',7AJJ1~1P~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH / / / Min -31- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0008 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ COMMON NAME / CHEMICAL NAME NITROGEN NON-FLAMMABLE Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM N SIDE HALL CAS# 7727-37-9 ~SolATdE ~ TYPE ~~PRen~URE TEMPERATURE CONTAINER TYPE Pure ~ Ambient OTHER - SPECIFY AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average LBS 500.00 LBS 250.00 LBS HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Nitrogen No 7727379 riE~GHI[L H~J~JJ1~1~1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH / / / -Min ~ Inventory Item 0011 Facility Unit: TREATMENT/DIAGNOSTIC 1ST FLO ~ COMMON NAME / CHEMICAL NAME COMPRESSED GAS NON-FLAMMABLE 250CF Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM N SIDE HALL CAS# 0 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TPure -Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 1500.00 FT3 750.00 FT3 ~Wt. RSI CAS# nr~ZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH / / / UnR HAZARDOUS COMPONENTS -32- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0004 Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ~ COMMON NAME / CHEMICAL NAME CO2/H2/N2 Days On Site 365 Location within this Facility Unit Map: Grid: LAB-MAIN CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE - ~Gas TMixture ~-Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 239.00 FT3 209.00 FT3 104.00 FT3 t11~GEitCL V U 5 lL V1~lY V1V ~1V 1 ~ owt. Rs cAS# 5.00 Carbon Dioxide No 124389 10.00 Hydrogen Yes 1333740 80.00 Nitrogen No 7727379 t1HGliitL Lj S~JL' ~~1~1J/1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Ext ~ Inventory Item 0005 Facility Unit: TREATMENT/DIAGNOSTIC 2ND FLO ~ COMMON NAME / CHEMICAL NAME CO2/N2 Days On Site 365 Location within this Facility Unit Map: Grid: LAB-MAIN CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TMixtur~Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 239.00 FT3 209.00 FT3 ~ 104.00. FT3 tit~GtitCLVU~ ~.v1~irVlvl~,1v15 %Wt. RS CAS# 10.00 Carbon Dioxide No 124389 90.00 Nitrogen No 7727379 t1HGHICL 1-~.7~J>~,.7iJ1~1!~,1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT#$ MCP No No No No/ Curies F P IH / / / Min. -33- 05/03/2007 F MERCY HOSPITAL SitelD: 015-021-000628 ~ ~ Inventory Item 0001 Facility Unit: TREATMENT/DIAGNOSTIC 4TH FLO ~ COMMON NAME / CHEMICAL NAME NITROUS OXIDE Days On Site 365 Location within this Facility Unit Map: Grid: STORAGE RM CAS# 10024-97-2 ~GdSATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE TPure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 56.00 LBS 700.00 LBS 350.00__ LBS t1AGKKLV U 7 l:Vl~lYV1Vt51V15 °sWt. RS CAS# 100.00 Nitrous Oxide No 10024972 ru-~~r-uu~ tiaa~a5i~i~1v15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0002 Facility Unit: TREATMENT/DIAGNOSTIC 4TH FLO ~ COMMON NAME / CHEMICAL NAME OXYGEN COMPRESSED Days On Site 365 Location within this Facility Unit Map: Grid: THROUGHOUT SURGERY AREA CAS# 7782-44-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 23.00 FT3 23.00 FT3 23.00 FT3 riHGAK1JVU~ C:UMYUN~N'1'~ owt. Rs CAS# 100.00 Oxygen, Compressed No 7782447 IlEiGEiKL H. 7~7~.7.71~1tS1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -34- 05/03/2007 F MERCY HOSPITAL ~ Inventory Item 0001 .COMMON NAME / CHEMICAL NAME ALCOHOL, ISOPROPYL Location within this Facility Unit N WALL COUNTER & CLOSET STATE TYPE PRESSURE TEMP Liquid TMixture ~ Ambient ~ Ambi SiteID: 015-021-000628 ~ Facility Unit: CARDIAC REHAB CENTER ~ Days On Site 365 Map: Grid: CAS# 67-63-0 ERATURE CONTAINER TYPE ent ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container .Daily Maximum I Daily Average 1.00 GAL 1.00 GAL 0.50 GAL ri1~GF~tC1JV U 5 l: V1~lY V1VL',1V T5 ~Wt. RS CAS# 70.00 Isopropyl Alcohol No 67630 t1E~GHKL H~~LaJ1~1~1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Mod -35- 05/03/2007 F MERCY HOSPITAL SitelD: 015-021-000628 ~ ~ Inventory Item 0005 Facility Unit: MRI ~ COMMON NAME / CHEMICAL NAME PHOTOGRAPHIC FIXERS Days On Site 365 Location within this Facility Unit Map: Grid: X-RAY DEVELOPER MACHINES, CANCER CENTER, NUCLEAR MED, CAS# SPECIAL DK RM, SURGERY DK RM, MAMOGRAPHY 64-19-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~mbient ~ Ambient OTHER - SPECIFY AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 30.00 GAL 239.00 GAL 333.00 GAL nti~.ytcL~u~ ~vrirv~.v~iv1J %Wt. RS CAS# 46.00 Ammonium Thiosulfate No 7783188 2.00 1,2-Butylene Oxide No 106887 5.00 Acetic Acid Solution No 64196 ru~~tjtclJ H~a~aai~i~ly 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Mod ~ Inventory Item 0002 ~ COMMON NAME / CHEMICAL NAME I HELIUM Location within this Facility Unit MRI UNIT TRUXTUN & A ST & EXT GATED AREA Facility Unit: MRI ~ Days On Site 365 Map: Grid: CAS# 7440-59-7 ~GasATE TPureE ~AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 2240.7.00 FT3 22407.00 FT3 22407.00 FT3 L'11iL.itiRLVUJ l.Vl"1rV1VP~1V1J %Wt. RS CAS# 100.00 Helium No 7440597 I1tiGHKL Ei. 7.7P~JJP71~,1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH DH / / / Min -36- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ ~ Inventory Item 0001 Facility Unit: MRI ~ COMMON NAME / CHEMICAL NAME NITROGEN Days On Site 365 Location within this Facility Unit Map: Grid: MRI UNIT TRUXTUN & A ST & EXT GATED AREA CAS# 7782-37-9 ~GasATE T TYPE PRESSURE ~~ TEMPERATURE ~~ CONTAINER TYPE ~ I Pure Above Ambient I Ambient I PORT. PRESS. CYLINDER I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 3930.00 FT3 6312.00 FT3 9468.00 FT3 - t1AG1itCLV UJ C:1J1~1r~1vL' 1v 15 °sWt. RS CAS# 100.00 Nitrogen No 7727379 ri1~Y,HKL Aa~i5J51~1L"1V17 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P R IH / / / Min -37- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 03/24/2000 ~ CALL 911. Employee Notif./Evacuation 10/20/1992 NOTIFICATION AND EVACUATION PROCEDURES IN ALL UNITS INITIATED BY FIRE ALARM SYSTEMS AND OVERHEAD PAGING SYSTEM. AREAS NOT REACHED BY OVERHEAD PAGING ARE NOTIFIED OF ALL ALERTS VIA LAND OR MESSENGER FROM COMMAND CENTER IN EVENT OF INTERNAL DISASTER DECLARATION. Public Notif./Evacuation REPORTED THROUGH EMERGENCY MEDICAL SERVICES (KERN COUNTY). 10/20/1992 Emergency Medical Plan 03/24/2000 MERCY HOSPITAL EMERGENCY DEPT. -38- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention 07/24/2006 ONGOING FIRE SAFETY PROGRAM FOR ENTIRE FACILITY, WHICH INCLUDES MONTHLY FIRE DRILLS - FIRE EXTINGUISHER INSPECTIONS, MONTHLY INSPECTIONS OF FIRE SPRINKLERS AND STANDPIPES. INSPECTIONS FOR OPERATIONS OF ALL FIRE AND SMOKE BARRIER DOORS. PREVENTIVE MAINTENANCE ON ALL FIRE PROTECTION RELATED EQUIPMENT. FIRE PLANS, DISASTER PLANS, ETC AVAILABLE 24 HOURS TO ALL EMPLOYEES. HOUSEKEEPING AGENTS ISOLATED IN DESIGNATED ROOM, EXCEPT FOR SMALL AMOUNTS USED BY PERSONNEL IN HOUSEKEEPING DUTIES. PAINTS AND FLAMMABLES KEPT IN SAFETY STORAGE CABINET LOCKER IN PAINT SHOP. FORMALIN KEPT IN SPECIAL CONTAINERS IN AMBULATORY SERVICES. SPILL KIT AVAILABLE FOR CONTROL OF SPILLS. INFECTIOUS WASTE CONTAINED IN UTILITY CLOSET, PICKED UP DAILY, Release Containment 07/24/2006 SPILL KITS AVAILABLE IN ALL HOUSEKEEPING CLOSETS. SPILL KITS AVAILABLE THROUGHOUT LABORATORY. SPILL KITS AVAILABLE IN RADIOLOGY DEPT. VERMICULITE AVAILABLE IN SECURITY VEHICLE. VERMICULITE AND OTHER ABSORBING PRODUCTS AVAILABLE IN ENGINEERING DEPT. Clean Up 07/24/2006 MINOR SPILLS CLEANED UP BY HOUSEKEEPING SERVICES FOR CLEAN UP CONTRACTED WITH CALPI INC. MINOR CLEAN-UP BY INDIVIDUAL DEPARTMENTS. CLEAN-UP AND DISPOSAL SERVICES BY SIERRA MEDICAL SERVICES FOR RADIOLOGY AREAS. -39- ~ 05/03/2007 .. ~ , P MERCY HOSPITAL SiteID: 015-021-000628 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Other Resource Activation 11/30/1998 AIR MONITORING BY CLEAN-UP CONTRACTOR. AIR MONITORING SERVICES BY COHR ENGINEERING SERVICES. AIR MONITORING SERVICES BY CTL ENVIRONMENTAL SERVICES. WASTE DISPOSAL BY CONTRACT BFI INC. -40- 05/03/2007 ,„ F MERCY HOSPITAL SiteID: 015-021-000628 ~ Fast Format ~ ~ Site Emergency Factors. Overall Site ~ ~ Special Hazards 03/24/2000 ~ RADIOISATOPES ON HAND RADIATION HAZARD. Utility Shut-Offs 03/31/2006 A) GAS - S WALL EXT BOILER RM B) ELECTRICAL - S WALL INT BOILER RM C) WATER - S OF S EXT WALL ADJ TO BOILER RM D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 02/05/2007 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS, W TOWER AND TREATMENT DIAGNOSTIC BLDG HAS SPRINKLERS, MAIN BLDG PARTIALLY SPRINKLERED. DRY STANDPIPES IN MAIN BLDG AND W TOWER AND TREATMENT/DIAGNOSTIC BLDGS, AND WET STANDPIPES IN SKILLED NURSING FACILITY. FIRE HYDRANT - SURROUND ENTIRE FACILITY. FIRE DEPT CONNECTIONS ON S WALL ON ER RAMP FOR WEST TOWER FD. FDC FOR MAIN BLDG NEAR OLD MAIN ENTR TO HOSPITAL AT TRUXTUN AVE. FDC FOR BUSINESS OFFICE ON ST PARKING LOT ENTR. FIRE DEPT SPRINKLER CONNECTION FOR NEW ENTRY AND CLEROU CONFERENCE ROOMS ON 16TH ST ON CRNR OF BOILER RM BLDG NEXT TO SERVICE ENTR BY TRASH COMPACTOR. Building Occupancy Level 1000 EMPLOYEES 03/31/2006 -41- 05/03/2007 F MERCY HOSPITAL SiteID: 015-021-000628 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 07/24/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: EACH EMPLOYEE TAUGHT TO USE MSDS AND SAFETY. ALL EMPLOYEES REQUIRED TO ATTEND GENERAL ORIENTATION WHICH COVERS FIRE SAFETY, HAZARD COMMUNICATIONS, GENERAL SAFETY AND MSDS. ALL EMPLOYEES ATTEND DEPT ORIENTATION. ALL EMPLOYEES REQUIRED TO ATTEND ANNUAL EDUCATION DAY (8 HRS). rage izciu iVi ru~.uic Vcc nclu 1VI L'ul..liLC VSC -42- 05/03/2007 ~ ~ jj --- - ~~~~~ ~ ~ ~ ~~~ ~Y - - - ,<< of ~ O k- '' ~ ~ ` ~ ~ l o~~) ~ -~~~ i~ ~ ~ i~~" ~-" ~ ~v:n~) ~. - ~ - - - r \ 131 i/ Eau oU ~ Cam,, C~~-~~-~ ~;~-~~~~ ~ ~ ~ ~ c ~ ~- x d l1JU'~.J ~~~~ ~t~ ~- +~I~,tiLD p`l~ ++~~ 1 ~ ~ CITY OF BAKERSFIELU F IRE DEPAR'T'MENT i~c 1 ~ M: OFFICE OF >?:NVIRONI~~iF.NTAL SERVICES `~ y~~ UNIFIED PROGRAM INSPECTION CHECKLIST \\~_,:w ~gti,0'~/ 1715 Chester Ave., 3~`' Floor, Bakersfield, CA 93301 ~~..~~i FACILITY NAME f~1c~rC~ 45t~~'t0.~ INSPECTION DATE ~ ~g "~ Section 2: Underground Storage Tanks Program ^ Routine [Combined ^ Joint Agency ^Molti-Agency ^ Complaint ^ Re-inspection Type of Tank ~U~ 5 Number of Tanks _ ~ Type of Monitoring C~~I'1 Type of Piping f~Gy FIc~ OPER,AT'ION C V COMMENTS Proper tank data on the Proper owner/operator data on tale Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? YeS No i Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection'? C=Compliance V=Violation 1'=Yes N-NO Inspector: ~ Office of Environmental Services (661) 326-3979 Business Site sponsible Party white - P~nv. Svcs. Pink -Nosiness Carv ,tt ~UNDERG OUN STORAGE TANKS BAKERSFIELD FIRE DEPT. fiR~ Prevention Services A1~TY T 900 Truxtun Ave., Ste. 210 APPLIC TI N ~ Bakersfield, CA 93301 TO PERFORM LD I NE TESTING ~ Tel.: (661) 326-3979 / S6989 SECO AR ONTAINMENT TESTING /TANK TIGHTN .~~,cST AND TO PERFORM Fax: (661) 85,2-2171 FUEL MONITORING CERTIFICATION ., Page 1 of 1 PERM(f NO. ~- ` ~ d ^ ENHANCED LEAK DETECTION ^ LINE TESTING ~ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TFST ^ TO PERFORM FUEL MONITORING CERTIFICATION ... . `'` T INF R TI N' FACILITY * NAME & PHONE NUMBER OF CONTACT PERSON I /~'~ J~R(~'~' ;t~ OWNERS NAME OPERATORS NAME /~ In,-' J (~ _ ~ S PERMIT TO OPERATE N0. O~ ~ - O~-O -~~~~ NUMBER OF TANKS TO BE TESTED I PIPIN IN T T T D? YE ^ N T C NTENTS o©~ I~SL ;.;. ., TANK;TESTING. COMPANY ,rl NAME OF TESTING COMPANY ~~ ~G , NAME & PH NE NUMBE OF NTACT PE~OK 7 75(~ MAILING ADDRESS rr nn,, ^^ ~.X l~ J'U ~ ~ t NAME PHONE NU BER F T STER OR SPECIAL IN-S7PECTOR ~- CERTIFICATION #: DATE & TIME T ~ T 0 B C~UCTED ICC #: ~ ~~ r ~~ TESJT_ NTHO ~ vD! SIGNATURE OF APPL A DATE APPROVED BY ti DATE a i~. FD 2095 (Rev. 09/05)