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Home My WebLink AboutBUSINESS PLAN 7-2007,., _ ~ VA OUTPATIENT CLINIC - - ~ ~~1 ~~ ~b~ I ~~ ~~ ~" ~~ ~ ~~ V ~J U i ~; :~1. ~H }r ~ 1~3 W /'~ ~ ~, i~~ VA OUTPATIENT CLINIC SiteID: 015-021-000268 Manager JOANN VANHORN Location: 1801 WESTWIND DR City :.BAKERSFIELD CommCode: BFD STA O1 EPA Numb: BusPhone: (661) 652-1801 Map 102 CommHaz Low Grid: 26B FacUnits: 1 AOV: SIC Code:8093 DunnBrad:95-652-1504 Emergency Contact / Title Emergency Contact /. Title JOANN VANHORN / SITE MANAGER ANNE SEYDEL / LAB SUPERVISOR Business Phone: (661) 632-1801x Business Phone: (661) 632-1801x 24-Hour Phone (661) 717-3992x 24-Hour Phone (661) 328-0558x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact BEN SPIVEY Phone: (310) 268-3565x MailAddr: 11301 WILSHIRE BLVD BLDG 218 RM 308 State: CA City LOS ANGELES Zip 90073 Owner DEPT OF VETERANS AFFAIRS US GOVT Phone: (661) 632-1801x Address 16111 PLUMMER ST State: CA City SEPULVEDA Zip 91343 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: $ ~PROG A - HAZMAT ' y ~ ~ ~ ~~~ ~ ~~~ E~2sed on my ir;quiry of those indiviciua~s re~pUrisii~}e for a"o'airting the intormat ion, I cA~rtity undE~r ;~enaity of lay- that I ha - ---- _- ve pcrsonaliy - -_-- -_-- - eKa~riirred and am famiii ,: - ~_ v nrtte - an , i~~lieve the information is true, ac c ura te , and co^i iet p e. / a g ~ Signature °- --1•~ ~'~ .t_„e .e Da e d f ^ ~~ ~ C.FJ~"11Tti i" wl V 1~1'~(~PJi~~' ~ ~"C~'' ~' ~~ - 1 V' ' ~ V -~ I~ 5~.~' ~.1.~ l ~ ' lN" i 07/16/2007 ., ./~ F VA OUTPATIENT CLINIC SitelD: 015-021-000268 Manager JOANN VANHORN Location:. 1801 WESTWIND DR City BAKERSFIELD BusPhone: (661) 652-1801 Map 102 CommHaz Low Grid: 26B FacUnits: 1 AOV: CommCode: BFD STA O1 EPA Numb: SIC Code:8093 DunnBrad:95-652-1504 Emergency Contact / Title Emergency .Contact / Title JOANN VANHORN / SITE MANAGER ANNE SEYDEL f LAB SUPERVISOR Business Phone: (661) 632-1801x Business Phone: (661) 632-1801x 24-Hour Phone (661) 717-3992x 24-Hour Phone (661) 328-0558x Pager Phone ( ) - ~ x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth r Contact -: (13'0 )-- - '~ _~ = ~ -Phone : - ( 8~-"~3-2 = 3.~8'J.~~ _ MailAddr: 11301 WILSHIRE BLVD BLDG 218 RM 308 State: CA ~~~ o~t2~~"~~lv' City LOS ANGELES Zip 90073 Owner DEPT OF VETERANS AFFAIRS US GOVT Phone: (661) 632-1801x Address 16111 PLUMMER ST State: CA City SEPULVEDA Zip 91343 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT ~~ ~' IAI ®~ ~oo~ Eased an my inquiry of these ind'+viduals responsible for obta;ning the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. -~ ,_ -` Date,~~_ Signature ~°°1 -1- 05/18/2007 F VA OUTPATIENT CLINIC ~ Hazmat Inventory = ~ MCP+DailyMax Order = SitelD: 015-021-000268 ~ ' By Facility Unit ~ Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F IH DH G 2500.00 FT3 Low NITROGEN F P IH G 460.00 FT3 Min -2- 05/18/2007 F VA OUTPATIENT CLINIC SitelD: 015-021-000268 ~ ~ 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: SW CRNR CAS# 7782-44-7 ~GaSATE ~ TYPE ~AboReSAmbEent TEMPERATURE CONTAINER TYPE Pure I ~ Ambient FIXED PRESS. CYLINDER .AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 2500.00 FT3 2500.00 FT3 HAZARDOUS COMPONENTS ~Wt. RS CAS# 100.00 Oxygen,- Compre"ssed - - "~ ~ -~"- --~ ---~ No°~ _ ~ 7782447 riAGl-CCU A~ ~Y5~~1~1L'~1V 1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME NITROGEN Location within this Facility Unit NE DENTAL CLOSET STATE TYPE PRESSURE _ Gas TPure ~-Above Ambient Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 7727-37-9 TEMPERATURE CONTAINER TYPE Ambient FIXED PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average FT3 460.00 FT3 460.00 FT3 - 111•i.AliiCLVUJ 1rt71•lYUlV~1V 1.7 _ , __ _ - _ owt. Rs _ cAS# 100.00 Nitrogen No 7727379 r11iGH2CL H. 7.7~A•71v1r+1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min -4- 05/18/2007 f ,: F VA OUTPATIENT CLINIC SiteID: 015-021-000268 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 01/18/2000 LEAD CLINICIAN AND SITE MANAGER ARE THE IMMEDIATE EMERGENCY CONTACTS FOR OUTSIDE AGENCIES. THEY INITIATE AN EMERGENCY CALL-BACK CASCADE PROCEDURE FOR ALL STAFF VIA TELEPHONE. ADDITIONAL NOTIFICATION OF THE DIRECTORS OFFICE AND EMERGENCY COORDINATOR AT THE VA MEDICAL CENTER, WEST LOS ANGELES OCCURS BY TELEPHONE. Employee Notif./Evacuation 01/18/2000 "- EMPLOYEES- IN THE- CLINIC' ARE`NOTIFIED-'OF~"P:'DISASTER ~OTHER~ THAN FIRE` THROUGH THE OVERHEAD PAGE SYSTEM. FIRE ALARMS RING THROUGHOUT THE BLDG AND THE SECURITY DESK IS NOTIFIED BY "FIRE WATCH" OF THE EXACT LOCATION. COMPLETE FACILITY EVACUATION PLANS ARE IN PLACE AND EMPLOYEES ARE TRAINED ON PROCEDURES FOR STAFF AND PATIENTS. Public Notif./Evacuation 01/18/2000 PATIENTS IN CLINIC ARE AMBULATORY (NOT AN ACUTE CARE OR EMERGENCY FACILITY) AND ARE EVACUATED BY STAFF PER DISASTER PLAN. Emergency Medical Plan 01/18/2000 THIS IS AN OUTPATIENT CLINIC WITH SUFFICIENT MEDICAL STAFF ON HAND TO PROVIDE EMERGENCY MEDICAL CARE IF NEEDED UNTIL AMBULANCES CAN TRANSPORT TO AN ACUTE CARE FACILITY. -5- 05/18/2007 F VA OUTPATIENT CLINIC SiteID: 015-021-000268 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention 01/18/2000 EMPLOYEES ARE TRAINED IN THE SAFE HANDLING AND USE OF ALL NON-REPORTABLE QUANTITIES OF HAZARDOUS CHEMICALS. CONTAINERS OF SUCH MATERIALS ARE LESS THAN A GALLON AND MINIMAL QUANTITIES ARE ON HAND. BULK STORAGE IS MAINTAINED AT VAMC SEPULVEDA WAREHOUSE. 9 Release Containment 01/18/2000 SMALL "NON-REPORTABLE_"QUANTITIES OF~ HAZARDOUS FLANII~IABLE--LIQUID'S ARE- STORED IN APPROVED FLAMMABLE STORAGE CABINETS WITHIN THE SITE. SUCH CABINETS ARE DESIGNED TO CONTAIN A LEAK AND PREVENT RELEASE. THE COMPRESSED GAS OXYGEN CYLINDERS ARE LOCATED AT THE EXTERIOR OF THE BLDG AND ARE CHAINED IN PLACE. ADDITIONAL COMPRESSED GAS NITROGEN CYLINDERS ARE LOCATED IN AN ENGINEERING CLOSET NEAR DENTAL CLINIC AND ARE CHAINED IN PLACE TO PREVENT RELEASE. Clean Up of/ls/2ooo ALL LABORATORY AREAS ARE REQUIRED TO HAVE CHEMICAL SPILL KITS CAPABLE OF HANDLING SPILLS OF 1 TO 2 LITERS OF LIQUID AND EMPLOYEES ARE TRAINED IN THE METHODS OF CLEANUP. NO REPORTABLE QUANTITIES OF HAZARDOUS MATERIALS ARE MAINTAINED AT BAKERSFIELD, EXCEPT FOR THE COMPRESSED GAS OXYGEN AND NITROGEN CYLINDERS. Other Resource Activation -6- 05/18/2007 !. e F VA OUTPATIENT CLINIC SitelD: 015-021-000268 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ 7jJeC:lct1 rid'Gdru~ Utility Shut-Offs 11/29/2006 A)-'~GP:S ~= GAS~NIETER `SE~ -CRNR" OF-BLDG" B) ELECTRICAL - MECH/ELECT RM SW CRNR NEAR EMER GEN C) WATER - WATER METER SE CRNR OF PROP CURBSIDE D) SPECIAL - OXYGEN TANKS AND SHUT-OFF MANIFOLD SW CRNR OF BLDG EXT E) LOCK BOX - NO Fire Protec./Avail. Water 11/29/2006 PRIVATE FIRE PROTECTION - FULLY SPRINKLERED AND CONNECTED TO A 24-HR FIRE ALARM MONITORING SERVICE (TEL-TEC), 18 ABC FIRE EXTINGUISHERS THROUGHOUT, 4 SMOKE DETECTORS CONNECTED TO AUTOMATIC FIRE WINDOWS IN PHARMACY AND CLINICAL CARE AREAS. NO ONSITE RESPONSE TEAM. NEAREST FIRE HYDRANT - 4 FIRE HYDRANTS - EACH CRNR OF PROP PARKING. Building Occupancy Level 11/29/2006 45 EMPLOYEES -7- 05/18/2007 ,:, F VA OUTPATIENT CLINIC SiteID: 015-021-000268 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 11/29/2006 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: SAFETY AND DISASTER TRAINING IS FOR EACH NEW EMPLOYEE AND ANNUALLY AS A REFRESHER. THIS TRAINING IS PERFORMED BY SAFETY SPECIALISTS AND INDUSTRIAL HYGIENISTS FROM THE SEPULVEDA VA MEDICAL CENTER. AS A FEDERAL FACILITY, ALL TRAINING IS IN ACCORDANCE WITH FEDERAL OSHA STANDARDS AND VA POLICY AND INCLUDE FIRE AND DISASTER EVACUATION PROCEDURES, USE OF EMERGENCY EQUIPMENT AND NOTIFICATION PROCEDURES. SPECIFIC REQUIREMENTS OF THE OSHA HAZARD COMMUNICATION STANDARD FOR THE SAFE USE AND HANDLING OF HAZARDOUS MATERIALS AND THE PROPER DISPOSAL OF HAZARDOUS = rctyC ~ Held for Future Use nc ll..1 1V1 t' uLULC Vb-C -8- 05/18/2007 UNIFIED PROGRAM INSPECTION CHECKLISTrt ii SECTION 1: Business Plan and Inventory Program Prevention Services g E a s F ,_ 0 900 Truxtun Ave., Suite 210 FIRE Bakersfield, CA 93301 ARTM r Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY N~^E NSPECTI - DATE INSPECTION TIME , ADDRESS - PHONE NO. ~ ' NO OF EMPLOYEES w~~9 [col In1~St z l8or ~ FACILITY CO~`~CT ` BUSINESS ID NUMBER 15-021- UL~D 26S ~ l~ N ~ d Section 1': Business Plan and Inventory Progrartt ~ ~~ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation COMMENTS ~' ^ APPROPRIATE PERMIT ON HAND ^ BUSIf1eSS PLAN CONTACT INFORMATION ACCURATE ! Y Q ~ 4y .. ^ ~ ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY I~- ! ^ VERIFICATION OF INVENTORY MATERIALS ~ ^ VERIFICATION OF QUANTITIES I ~ ^ VERIFICATION OF LOCATION Cpl' ^ PROPER SEGREGATION OF MATERIAL O C~ ^ 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 C~ NO EXPLAIN: /~ ", rear-bui~ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 • j~JO tn~ Inspector (Please Print) Fire P evention / 1s` In /Shift of Site/Station # White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05 • UNIFIED PROGRAIOA INSPECTION CHECKLIST SECTION 1 Business .Plan and inventory Program Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel: (661) 326-3979 FACILITYNAME r ~ -_- ---- PECTI---DATE- -- - -_ CTIONTIME -- U/ o~~ ~~ ~~-~- Gl~~,: ~ 'jam-~~-dam ADDRESS PHONE No. No. of Employees FACILITYCONTAC7 Business ID Number ~~ , ~ / q~.~-, 1 S-O21- c~ D o a- ~~ Section 1: Business Plan and Inventory Program Routine O Combined O Joint Agency OMulti-Agency O Complaint O Re-inspection ANY HAZARDOUS WASTE ON SITE?: ^ YES ,~FIO EXPUIIN: e QUESTIO REGARDING THIS INSPECTION? PLEASE CALL US AT (661 ~ 3Z6-3979 Ins ctor (Please Print) Fire Prevention 1 sl-INShift of Site White -Environmental Services Yellow -Station Copy ~~ Business Site Responsible Party (Please Print) rn B N Pink -Business Copy ~ ,~ ~ 5 tio03 ~~LD af,~~ CITY OF BAKERSFIEI.D FIRE DEPARTMENT N4~ •~ OFFICE OF ENVIRONMENTAL SERVICES ~ UNIFIED PROGRAM INSPECTION CHECKLIST w,~a~~i 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME VA o~ccer~Tt~-~'r [,t_t-~tC.. INSPECTION DATE~~a3 _ ADDRESS 1$D~ .o6,s7u~iND gyn.- PHONE NO. (~ (~a~-llrai (~Q~3YS-~Y7y FACILITY CONTACT ~oti'~G S~ ~-r,vN BUSINESS ID NO. 15-21U- , INSPECTION TIME IS30 ~}ns NCiMBER Or EMPLOYEES `IO - Section 1: Business Plan and Inventory Program [Routine ^ Combined ^ Joint Agency ^Muhi-Agency ^ Complaint (] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand ~p~c,Ps~c Fp~~ ~~-(.,t`1Gc.~ Business plan contact information accurate Visible address Correct occupancy /~ Verification of inventory materials ,~ Verification of quantities verification of location Proper segregation of material Verification of MSDS availability Verification of Naz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled t/ Housekeeping ~~ Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Q Yes ~.No Explain: Questions regarding this inspection? Please call us at (661) 326-3979 Whitr -Env. Svcs. Yellow - Suuion Copy Pink -Business Copy x A1NV~ /O/~- Bu"sines Site Responsible Party inspector: MRtt'( ~DI,,)L,4Nb 1 t