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Home My WebLink AboutBUSINESS PLAN (2) ~, ~% f /' ~~ EVERGREEN HEALTHCARE i -- j',. ,~,, ~ 6212 TUDOR WAY o`j ~- ~~, a. i,' :~ ~~ ~~~ ~~ ~y~- ~~f JUN-13-06 12:32PM FROM-EVERGREEN HEALTHCARE CENTER BAKERSFIEIb +6618711388 T-252 P.~2t~9 F-U69 9402/ZZ/£Q -I- 1 ~ ~ q ~ ~ ~ ~ _ ~ 0~~ l~ l~ 'an.~t ~~ s~~7~t~u~a~~t eye ~3n:~~;:~~; shit: ~~~la;sur~n~ kiog~u,IJUjsn oy~ ytirtn at;,piu~; 4[,2 g~1~ rr}as~u,t;e,:a ~CSleuusjKC~ anei~ ~~s;i ~~~ 1c, ns4etuaC 3~3~Un -I~~~~SJ ~ 'uf]rdeusu]-Ut ~4: `14lltatt;l,~gt7 .u~ 8;c!i:;u0[~:;dj 90 T s~en~xin~pui flsoy: }c~ !~1sr~bu,, ~.w ua n;~srr0 O?, ~ .b ~ ~01 aoox rrtt~aa - ~ ~oxa ~) ~ - ~ s~z~ - ~ ooxa sant~aa.ztQ ~auabxatu~ : oHlaa.z~a off =ssx =p,~z~~ao Z~ _ ~s~SIIYE~oy :~az~da.zd ~~ _ :ssS~T~~os o~ - pa~aad 29986 ~ dtZ 2i3ISC10~i~I1L ~ ~~Z~ rdM =a~~'~9 00£ 3n~I H~GL ~L~I X49$ = ssaxpl~X x £ £ Z € - ~ L 8 { ~ 9 9 ) : auor~g 3~dJHS~IFI'3H 1~iS~iJ?I~AS ~~LTMQ 90FE6 dz2 Q'I~I.3S2II?iKS ~ ~~~~ ~ =a'~~~5 AYa'M 2iOQlls ZTZ9 =zpFKT?~I xTZi~6-SZ€ (799) :auoud ZT.is00~ 1~II~i2iKQ = ~ste~uo~ t------------------------------~~---------~'-------------------~- -------------fi ~ u~ZHuuul ssazg a~~,d : sp~>?z~H ~tnuzaH E +---~-------~~---..___m.._..__.._----------+---------------------------------------+ ~[ - ( ) auoug xabEd xZ9E'C-96~ {299) = auQua ~ab~d x - ( ) au0ud ~noH-fiZ x9ii9Z-6Z€ (Ig9} = auor~d ~Y10H-iiZ x - ( ) ~auQZ;d ssauisng x€€-~~-~G8 {"~99) =auot;a ssaurstlg / 2Id~1S ~1rl~Tdlni / Z,I,i~ia0~ 1~II2i2iFiQ at~zs / ~a~~uo~ .haua~,xaut3 al~iy / ~a~~uoo 1Cauabzatug ptezgutm~ = clumi~ ~'a3 : a~ioo ~ Y S Z ~ ~'.I.S Q3a?I = apo~ttnuoo -no~z ~ =s~zuAae3 s~I :Pzz~ aZ3I3sx3x~H ~~'~~ zlbiH z~'H~~a~ EO'C ~ daGl A'~i'M ~io¢[,l.I, Z~Z9 =uo-r~~aoZ E £ ~ £ - 11.8 (I 9 9 ) = auoud sr-S = ~aF~ t E~i~000-~ZO-520 =QIa~zS ==T____________________________= H2Trd"~H,L'IF~3H L~i33~iJ2i3LL'3 + ~ .~ ~`' ''~`' ~j~C~-' ~~ ~'~ UNIFIED PROGRAM INSPECTION CHECKLIST?; rfwi SECTION 1~:x 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 FACILITY NAME NSPECTION DATE NSPECTION 71ME ADDRESS ~ ~l ~ ~~ HONE NO. ~= I ~ l O OF EMPLOYEES .~ FACILITY CONTACT C USINESS ID NUMB R 15-021- eti --~ Section 1: Business Plan and Inventory Program l ~~-- ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION • C V ~ C=Compliance OPERATION V=Violation COMMENTS g/^ APPROPRIATE PERMIT ON HAND ^ BUSIt12SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY (~ ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL i ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND ROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE ~ ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES ~d8 T ~ a ~ESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ` Inspector ( ease Print) ire Preventio 1°' In / Shift of Site/Station # Bu mess Site/School Site R~ White -Prevention Services Yellow -Station Copy Pink -Business Copy FD204e (Rev. 02/05) " ,~; + EVERGREEN HEALTHCARE __________________ ______________ SiteID: 015-021-000143 + 3;3 3 r~IIQ ~ anager ^ _ BusPhone : ( 661) .~--~ ocation: 6212 TUDOR WAY Map 103 CommHaz Moderate City BAKERSFIELD Grid: 14B FacUnits: 1 AOV: CommCode: BFD STA 08 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title DARRIN COONTZ / MAINTENANCE SUP / Business Phone: (661) 871-3133x Business Phone: ( ) - x 24-Hour Phone (661) '`max 24-Hour Phone ( ) - x Pager Phone ( '""-) ~y~ ~~ x-; ~~( _ b ~-. ~6~ . Pager Phone ( ) - x _ _ _ Hazmat Hazards: Fire Press ImmHlth Contact Phone: (661) 325-9421x MailAddr: 6212 TUDOR WAY State: CA City BAKERSFIELD Zip 93306 Owner EVERGREEN HEALTHCARE Phone: (661) 871-3133x Address 4601 NE 77TH AVE 300 State: WA City VANCOUVER Zip 98662 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal ertif'd: RSs: No _ arcelNo: Emergency Directives : ~~Q~`~/' J `~~ c~v~IfQs ~t!~ ` ~,L __ ~-~ /~ -~, .,, ~;, ~'~~. ------------------------------------------------------------------------------ -1- 11/08/2005 T ~, ~ ~. r ~~ EVERGREEN HEALTHCARE SiteID: 015-021-000143 Manager JOHN MARVIN Location: 6212 TUDOR WY City BAKERSFIELD BusPhone: (661) 871-3133 Map 103 CommHaz Extreme Grid: 14B FacUnits: 1 AOV: CommCode: KCFD STA 42 EPA Numb: SIC Code: DunnBrad: .Emergency S2w,,,ra.~r / Title ` Emergen`c,~ Co Intact / Title f.j~,r,~ ~,~ ° ~~ ~ ~ U K / MAINT SUPR ~ at fez /"lam i ~ : ~T: /~~CLc:;%~: ~r~Dcrece~ Business Phone: (661) 871-3133x Business Phone: (~,(~~ ) a-~~ -~~-~~~x 24 -Hour Phone ( 661) "~'~-'~"-~=- ""` ''~`'~~ ~"7~~ 4Nnb 24 -Hour Phone ( ) - x Pager Phone (661) Pager Phone (~(,~ )t~~~ -~a Hazmat Hazards : ~:3 ~ - ~~~ ~ Fire Press ImmHlth Contact JOHN MARVIN Phone: (661) 871-3133x MailAddr: 6212 TUDOR WY State: CA City BAKERSFIELD Zip 93306 Owner EVERGREEN HEALTHCARE Phone: (661) 871-3133x Address 4601 NE 77TH AVE 300 State: WA City VANCOUVER Zip 98662 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG C - COMM HOOD ~~~¢~ ~~~ `~ ~~~~ 0«~ved on my inquiry of those individuals respansible for obtaining the infarmatian, I certify under penalty of law that I have personally examined and am familiar with the infarmation submitted and believe the information is true, accurate, and complete. _ ~°~ ~ 3~~~ ~• re Date ~X ~~-:.~ ~ J~ -1- 10/03/2007 ;. F EVERGREEN HEALTHCARE ~ Hazmat Inventory = ~ MCP+DailyMax Order = SiteID: 015-021-000143 ~ By Facility Unit ~ Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP PROPANE OXYGEN E F P F P IH IH G G 1369.00 1280.00 FT3 FT3 Hi Low -2- 10/03/2007 i T. ~ , -3- 10/03/2007 `~, F EVERGREEN HEALTHCARE SiteID: 015-021-000143 ~ ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ ~ COMMON NAME / CHEMICAL NAME PROPANE Days On Site 365 Location within this Facility Unit Map: Grid: NEXT TO GEN SW CRNR OF BLDG STATE T TYPE Gas I Pure = PRESSURE TEMPERATURE _ Above Ambient Ambient AMOUNTS AT THIS LOCATION Largest Container Daily Maximum 1369.00 FT3 1369.00 FT3 Daily Average 950.00 FT3 t1AG1-1hCLVUS C.:U1~1r~1vL~1v~15 %Wt. RS CAS# 100.00 Propane Yes 74986 r1t~~tatcL ta5 ~~~51~i~ivla TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: 02 RM SE OF NURSING STA CAS# 7782-44-7 ~GasATE TPureE ~AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 350.00 FT3 1280.00 FT3 1024.00 FT3 11EiGHtCL V U 5 lr V 1~1Y V1V L' 1V 15 %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 riL~GEiCCL 1-~A J~751~1~1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low CAS# 74-98-6 CONTAINER TYPE = FIXED PRESS. CYLINDER -4- 10/03/2007 F EVERGREEN HEALTHCARE SiteID: 015-021-000143 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 07/13/2006 ~ WEBB FIRE PROTECTION SERVICE CONDUCTS REGULAR DRILLS, INCLUDING NOTIFICATION PROCEDURES. NOTIFICATION TO ADMINISTRATOR AND MAINTENANCE SUPERVISOR, THEY OR THEIR DESIGNEES NOTIFY APPROPRIATE AGENCIES AND COORDINATE EVACUATION PROCEDURES ACCORDING TO EVACUATION PLAN APPROVED BY STATE FIRE MARSHALL. Employee Notif./Evacuation 04/26/1990 STATE FIRE MARSHALL HAS APPROVED OUR PROCEDURES FOR EMPLOYEE NOTIFICATION AND EVACUATION. Public Notif./Evacuation APPROVED FIRE/DISATER PLAN CONTAINS PROCEDURES. 07/13/2006 Emergency Medical Plan 04/26/1990 APPROVED FIRE/DISASTER PLAN CONTAINS PROCEDURES. -5- 10/03/2007 F EVERGREEN HEALTHCARE SiteID: 015-021-000143 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 07/13/2006 ~ CHAINS FASTENED TO WALL CONTAIN OXYGEN TANKS IN STORAGE. OXYGEN TANKS ON CARTS ARE STRAPPED FOR TRANSPORT. PROPANE TANK (FUEL SUPPLY FOR GENERATOR) IS PROTECTED BEHIND 6 FT FENCE. LCCICQ.7C l..Vll 1. C1111L1IC11V 1.1C0.11 IJ~J V1.11C1_ 1CC~VULC:C tiC:l.lVdl.lVi1 -6- 10/03/2007 F EVERGREEN HEALTHCARE SiteID: 015-021-000143 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ .~~c~.lai riac.ai.ua Utility Shut-Offs 04/11/2007 GAS - NW CRNR OF BLDG ELECTRICAL - SW CRNR OF BLDG WATER - SW CRNR OF BLDG AND MAIN VALVE SE CRNR OF SITE Fire Protec./Avail. Water 07/13/2006 PRIVATE FIRE PROTECTION - SMOKE DETECTORS, FIRE EXTINGUISHERS, AND SPRINKLER SYSTEMS. FIRE HYDRANT - FRONT SE OF BLDG. Building Occupancy Level 04/11/2007 86 EMPLOYEES -7- 10/03/2007 ., F EVERGREEN HEALTHCARE SiteID: 015-021-000143 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 07/13/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUNIMARY OF TRAINING PROGRAM: ORIENTATION AND IN-SERVICE TO ALL STAFF. WEBB FIRE PROTECTION SERVICE TRAINS AND CONDUCTS MONTHLY FIRE DRILLS AND DISASTER DRILLS. rayc c i1C ll..1 LV1 t UI~ULC Vw~'C 1ZC 1~A 1VL lUI.ULC UDC -$- 10/03/2007