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HomeMy WebLinkAboutBUSINESS PLAN i II _ i ~ ADVANCED HEART & MED CTR :5343 TRUXTUN AVENUE _ _ _~ _~ ;,. y. + ADVANCED HEART & MEDICAL CENTER _____________________ SiteID: 015-021-002272 + Manager Location: 5343 TRUXTUN AVE City BAKERSFIELD BusPhone: (661) 861-7933 Map 102 CommHaz Low Grid: 34B FacUnits: 1 AOV: CommCode: BFD STA 11 EPA Numb: SIC Code:8011 DunnBrad: *______________________________________________________________________________t Emergency Contact / Title Emergency Contact / Title DELORES BROOKS / / Business Phone: (661) 861-7933x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact DELORES BROOKS Phone: (661) 861-7933x MailAddr: 5343 TRUXTUN ANTE State: CA City BAKERSFIELD Zip 93309 Owner Phone: ( ) - x Address 5343 TRUXTUN AVE State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparer:_ TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT EN~p JuN . D 9 2pp6 Based on my Inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that 1 have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. Signature Dat ~~\ -1- 03/13/2006 UNIFIED PROGRA-IVI INSPECTION CHECKLIST=, BIRO .n:~a,kaasr..-.~~cv~*~'s>:,....r~r,~r,..-,~rt^rr«F~~-z °..~~..:a. ....,~_~;.v~.:~~. .~:•..., ..:~.u~~e - A~T~ 1r SECTION 1: Business Plan and Inventory Program ~' BAKERSFIELD FIRE DEPT Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 ~c~ _ FACILITY NAME ~ " ~ ~ ~ INSPECTION DATE_ ~t--~-~) INSPECTION TIME !!ate .. i , a ~~ ( 1. 6 ADDRESS HONE NO. ~ ~"7~~ O OF E~OYEES '(Z lU ~ FACILITY CONTA t, /~ re f /` ~~/r s USINESS ID NUMBER 15-021- 6 d ZZ? ?~ Section 1: Business Plan and Inventory Program ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS _ ^ APPROPRIATE PERMIT ON HAND L N" - / ~/ ^ BUSIII2SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS CJ]~^ CORRECT OCCUPANCY C{~^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~ ~. ~~~~~y~'~~ t i ~ Inspector (Please Pfint) Fire revention / is' In /Shift of Site/Station k ess SitelSchool Sit esponsible Party (Pleas rint) White -Prevention Services Yellow -Station Copy Pink -Business Copy ^ YES lj~NO zn~s FD2049 (Rev. 02/05) UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1: ,Business Plan and Inventory Program Prevention Services a F a s ~ , , n 900 Truxtun Ave., Suite 210 F/RE Bakersfield, CA.93301 ARTM r Tel.: (661) 326-3979- Fax: (661) 872-2171 FACILITY NAME - NSPECTI ON DATE INSPEC ION TIME T / _ ~'. ^ S ~{ ^~ h-(r LvV _ / / I ~ vV ~,~VLtn ADDRESS PHONE NO. NO OF EMPLOYEES ~3 ~ 112~c, ~ ~ /^ 7 'FACILITY TACT BUSINESS ID NUMBER - 15-021- G~Z272~ Section 1: Business Plan and Inventory Program.. - - =_- _ ___s~!- L ~ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (C=Compliance` .OPERATION V=Violation l COMMENTS ^ APPROPRIATE PERMIT ON HAND !I ^ BUSIt1eSS PLAN CONTACT INFORMATION ACCURATE 7 ~ ~N 1 ,D ~ ~ (? ~ , V ~ ^ VISIBLE ADDRESS ~;, ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL t ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~ ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ~NO EXPLAIN: STIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~~~ ~' f ector (Please Print) Fire Prevention / 1" In / Shift o Site/Station Business Site / Re ponsibl .Party (Please Print) White -Prevention Services ~ - - - Yellow -Station Copy _ - Pink -Business Copy ~ FD 2155 (Rev. 09/05 ~^ 1, ADVANCED HEART & MEDICAL CENTER SiteID: 015-021-002272 Manager DOLORES BROOKS Location: 5343 TRUXTUN AVE City BAKERSFIELD BusPhone: (661) 861-7933 Map 102 CommHaz Low Grid: 34B FacUnits: 1 AOV: CommCode: BFD STA 11 EPA Numb: SIC Code:8011 DunnBrad: Emergency Contact / Title Emergency Contact / Title DOLORES BROOKS / OFFICE MANAGER / Business Phone: (661) 861-7933x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact DOLORES BROOKS Phone: (661) 861-7933x MailAddr: 5343 TRUXTUN AVE State: CA City BAKERSFIELD Zip 93309 Owner TONY LEGGIO Phone : ( lvl~ 1 )~~~ -yBUC~ x Address 5343 TRUXTUN AVE State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT EN~'p ~u~ ~ ~ . . X007 F3ased on my inquiry of those individuals responsible for obtaining the information, 1 certify under penalty of IaN! that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. Signature Date -1- 06/29/2007 r ., F ADVANCED HEART & MEDICAL CENTER SiteID: 015-021-002272 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F IH DH G 200.00 FT3 Low -2- 06/29/2007 -3- 06/29/2007 F ADVANCED HEART & MEDICAL CENTER SiteID: 015-021-002272 ~ ~ 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: MGRS OFFICE & TREADMILL RM CAS# 7782-44-7 ~GasATE TPureE ~AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 24.00 FT3 200.00 FT3 200.00 FT3 Y1HGtitCLVU.~ l.Ul"lYUlV ~1V 1.7 oWt. RS CAS# 100.00 Oxygen, Compressed No 7782447 I3HGHtCL L-17~J;7.71~1J~,1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -4- 06/29/2007 F ADVANCED HEART & MEDICAL CENTER SiteID: 015-021-002272 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ r~yclllry 1VV1.1111:d1r1V11 i -.. P~LLL~J1VyCC 1VV 1.11. ~ L' VdC:Udl.l Vll i~ t Ui.J11t. lVV V11 ~ ~VdC.Udl.1 V11 r~u~ctyvuvy 1.1CU1Ud1 Yldil -5- 06/29/2007 F ADVANCED HEART & MEDICAL CENTER SiteID: 015-021-002272 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention Release Containment ,,, V 1GGlil Vi./ v 1..ilc1 1ZG.7V Ut VG til: l.lV0.l.l Vll 9 -6- 06/29/2007 F ADVANCED HEART & MEDICAL CENTER SiteID: 015-021-002272 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ _, .~~c~la.L nac~aLU~ V1.1111..y J11U 1.-VLly.- i- 1'1LC tLVI.CL./HVd11. WdI.CL D U11U111C~. VC:C: U~Jd11C ~/ LCVe1 -7- 06/29/2007 F ADVANCED HEART & MEDICAL CENTER SiteID: 015-021-002272 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training ruyC ~ nciu i.vt i u~.uic vac Held for Future Use -8- 06/29/2007 UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY A/nM~E////~~ ``nn //~~rrAA ,,jjam~ '/ /~ /~ INSPECTIOQN DATE INSPECTION TIME ADDRESS rL~O~ _ _5"3_9`3 T__iCU__X 3~u__i/ _/_~-~/~ ---____-__---- ~--~'~ - - ~ 0~ PHONE No. No. of Employees Sl°~-71'3 -------------- Business ID Number F.4CI~ITYCONTACT ~ LO ~ ~t9 15-021-Ob22~ Section 1: Business Plan and Inventory Program L~ROUtine ^ Combined ^ Joint Agency ^MuIti-Agency ^ Complaint ^ Re-inspection C ^ V ^ IV=Voatonncel OPERATION APPROPRIATE )PERMIT ON HAND COMMENTS ^ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ ^ VISIBLE ADDRESS ^ ^ CORRECT OCCUPANCY ^ ^ VERIFICATION OF INVEN70RY MATERIALS ^ ERIFICATION OF QUANTITIES - - VERIFICATION OF LOCATION ^ ^ PROPER SEGREGATION OF MATERIAL ^ ^ VERIFICATION OF MSDS AVAILABILITYE ^ ^ VERIFICATION OF HAT MAT TRAINING ^ ^ ^ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES EMERGENCY PROCEDURES ADEQUATE ------ ~-------- --- _ - ^` - V-. ~~~~~~d 3 ^- -^--_- --- ----------------- ~~--~,---r--~---_---- ^ ^ CONTAINERS PROPERLY LABELED ^ ^ HOUSEKEEPING _ ^ ~s ©UT / ^ ^ __ - _ FIRE PROTECTION `_ _, ~_ ^--- ^ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE: ^ YES ^ NO EXPLAIN: 5 ~ ~'~' Dy ~ ~/©r- -~,eLy~ .~i ,r/1~ C~S~G1.r/.~ ,~s ~~ /^' QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT (66~ ~ 3ZB-3979 Inspector Badge No. Business Site Responsible Pally White -Environmental Services Yetlow - Statbn Copy Pink -Business Copy l