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HomeMy WebLinkAboutBUSINESS PLAN® PLAQUE ATTACK 1491 WHITE LANE _ _ ~, ~g d ~/ BASERSFIELD FIRE DEPT r. * s Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST ~~ts 90oTruxtunAve., suite 210 SECTION~1~. ,~Busi ,...Hess Plan and In ~ .. '. ,~ . _ _~ ~~>rr Bakersfield, CA 93301 yB~pry Pf p91~n1 ~ Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME ~~ <~ ^ ~~ ~ ~~~ ~ ~ NSPE I; N D T~ INSPECTION TIME ~ ADDRESS / ~~ C~ ~ ~` ~ ~ ~ f 1 I `~'-` 'Avg HO~NO ~' ~~ ~VJ '-!7 O OF EMPL,QYEES 6 FACILITY CONTACT USINESS ID NUMBER ~~0 15-021- Section 1: Business Plan and Inventory Program ^ ROUTINE 1~'j COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (c=compliattce) OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSInBSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ ^ ^ . CORRECT OCCUPANCY VERIFICATION OF INVENTORY MATERIALS VERIFICATION OF QUANTITIES -~~,~ ~.~~ ~~ ~~ ~o~ ^ 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 ^ CONTAINENS PROPERLY LABELED ') ~ ,~.,~ ,G ,~,L~g t r}O .f~ q LL ~ bQ ~ Q ~ to gS~ ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND i t)C a /` ANY HAZARDOUS WASTE ON SITET ~~.~ YES ^ NO EXPLAIN: ~ g 5`tt X d r QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (681) 928-3879 Inspector (Please Print) Fire Prevention / t" to / Shift of SRe/Station White - prevention S~rvieas Yellow -Station Copy pink - Buainasa Copy FD20~9 (Rev. 02/05) -s s ~. ,04y~- -T~'`e ~~ ~' ~W .y ~j O~p.~ '~ FACILITY NAME ~~~~E CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3`d Floor, Bakersfield, CA 93301 ~-CT~c ~ INSPECTION DATE ~ ~~ O Section 4: Hazardous Waste Generator Program EPA ID # ~ ~ ~ fl7 ^ Routine ~ Combined ^ Joint Agency ^Muiti-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number £x ~ ~,,,~-i- Authorized for waste treatment and/or store e 5-.~~, f-t- Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not Peaking Containers are compatible with tote hazardous waste Containers are kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line ~ Secondary containment provided ~ "-~""1 SeLO~ a, ~ C~~~ Conducts daily inspection of tanks Used oil. not contaminated with other hazardous waste j~ -~ Proper management of lead acid batteries including labels Qu /.~, Proper management of used oil filters Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years ~c,.~ ~ ~ q ~~ fs~.-- ~ n~"9 Retains hazardous waste analysis for 3 years S V. P~ Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal ~.=~,ompnance v=vtotanon Inspector: ~~ '~~' ' "` ~ Office of Environmental Services (661) 326-3979 Business Site Re nsible Party White -Env. Svcs. Pink -Business Copy ~ 1 r PLAQUE ATTACK SiteID: 015-021-002904 Manager NOEL DOROTHEO DMD Location: 1491 WHITE LN City BAKERSFIELD BusPhone: (661) 827-9183 Map 124 CommHaz Minimal Grid: 18A FacUnits: 1 AOV: CommCode: BFD STA 05 EPA Numb: SIC Code: DunnBrad: Emergency Contact /- Title Emergency Contact / Title ~ / Business Phone: ~( ) - x Business Phone: ( ) - x 24-Hour Phone `( ) - x 24-Hour Phone ( ) - x Pager Phone ( _) - x Pager Phone ( ) - x Hazmat Hazards: Contact NOEL DOROTHEO DMD Phone: (661) 827-9183x MailAddr: 1491 WHITE LN State: CA City BAKERSFIELD Zip 93307 Owner NOEL DOROTHEO DMD Phone: (661) 827-9183x Address : 1491 WHITE LN State: CA City BAKERSFIELD Zip 93307 Period to TotalASTs: - Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN (~~~ ~N°~~~ ~ ~~ ~ ~ ~pO7 t:3n<.ed on my inquiry of those individuals the information, I certify i ng respc~r~~ ibl~> for obtain that 1 have personally under penalty of law mined and am familiar with the information e , exa the information is tru bmitted and beli su lete accurate, and comp ` ~ /g - ©~ .rte ~~ ~~^or -'''Signature Date -1- 04/18/2007 F PLAQUE ATTACK SiteID: 015-021-002904 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE FIXER L 5.00 GAL Min -2- 04/18/2007 -3- 04/18/2007 r ~ F PLAQUE ATTACK ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME WASTE FIXER Location within this Facility Unit E SIDE LAB STATE TYPE PRESSURE Liquid TWaste -T Ambient SitelD: 015-021-002904 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 3.00 GAL rlti~xrcuvu5 ~:uinruiv~ly t a $Wt. RS CAS# Silver No 7440224 t11~GH.CCL E~J JL" ~J1~1L" 1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Min -4- 04/].8/2007 {_ ~ F PLAQUE ATTACK SiteID: 015-021-002904 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 03/19/2007 ~ CALL 911 Employee Notif./Evacuation VERBAL NOTIFICATION. EXIT OUT EITHER FRONT OR BACK DOOR. 03/19/2007 Public Notif./Evacuation VERBAL NOTIFICATION. EXIT OUT EITHER FRONT OR BACK DOOR. 03/19/2007 Emergency Medical Plan 03/19/2007 CALL 911 -5- 04/18/2007 F PLAQUE ATTACK SiteID: 015-021-002904 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 03/19/2007 ~ SECONDARY CONTAINMENT. COVERED WHEN NOT IN USE. Release Containment 03/19/2007 SECONDARY CONTAINMENT AND ABSORBANT. Clean Up PAPER TOWELS AND ABSORBANT. 03/19/2007 Other Resource Activation -6- 04/18/2007 q _ , ,: ~ PLAQUE ATTACK SiteID: 015-021-002904 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ JjJCC;1d1 ricl'Gdl-c1S Utility Shut-Offs 03/19/2007 S SIDE OF BLDG Fire Protec./Avail. Water SPRINKLER SYSTEM FIRE HYDRANT - PARKING AREA 03/19/2007 Building Occupancy Level 03/19/2007 20 EMPLOYEES -7- 04/18/2007 .., ;: F PLAQUE ATTACK SiteID: 015-021-002904 ~ Fast Format ~ ~ Training. Overall Site ~ Employee Training -- -, rayc c nciu ivi ru~utc vac nctu 1V1 rul.lA1.C UAC -8- 04/18/2007 ;~ PLAQUE ATTACK Manager NOEL DOROTHEO Location: 1491 WHITE LN City BAKERSFIELD CommCode: BFD STA OS EPA Numb: SiteID: 015-021-002904 BusPhone: (661) 827-9183 Map 124 CommHaz Minimal Grid: 18A FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact j Title Emergency Contact / Title / OWNER C-c~,~.r~..~l ~'~'h / Business Phone: (661) 827-9183x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Contact NOEL DOROTHEO Phone: (661) 827-9183x MailAddr: 1491. WHITE LN State: CA City BAKERSFIELD Zip 93307 Owner t d,~aYd (aY.cbv SOS Phone: (661) 827-9183x Address 1491 WHITE LN State: CA City BAKERSFIELD Zip 93307 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ~N~'~ ~ ~ ~' i ~ ~~~~' . ~ ~ I ~1 1: .r f'f ~},. ~,? irl COY, .: ,. I.. ~n; ^,~ , , ;i ..:~~iil~?.r ~ti^:h the 'nicrmutio~ s;::~~.:~_1„r, ; -_ _ ~;!i;.•!e the i~;'rormafion is true, a~.c~;r.,iF~, ~}nr~ cornnlete. ~~ ~~~ I ~ - Cs o~ i _ Siyir~~iu: a date -1- 10/10/2007 F PLAQUE ATTACK SiteID: 015-021-002904 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... ISpecHazIEPA Hazards) Frm I DailyMax IUnitIMCPI WASTE FIXER L 5.00 GAL Mini -2- 10/10/2007 -3- 10/10/2007 F PLAQUE ATTACK ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME WASTE FIXER Location within this Facility Unit E SIDE LAB STATE TYPE Liquid TWaste SiteID: 015-021-002904 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# = PRESSURE TEMPERATURE CONTAINER.TYPE Ambient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 5.00 GAL 3.00 GAL -- ru~~titcl~uu~ uulnrulvl;lv~l~5 %Wt. RS CAS# Silver No 7440224 t1F~GH.1<L E~~~L' S~1~1JJ1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / Min -4- 10/10/2007 F PLAQUE ATTACK SiteID: 015-021-002904 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 03/19/2007 ~ CALL 911 Employee Notif./Evacuation VERBAL NOTIFICATION. EXIT OUT EITHER FRONT OR BACK DOOR. 03/19/2007 Public Notif./Evacuation 03/19/2007 VERBAL NOTIFICATION. EXIT OUT EITHER FRONT OR BACK DOOR. Emergency Medical Plan 03/19/2007 CALL 911 -5- 10/10/2007 l ` F PLAQUE ATTACK SiteID: 015-021-002904 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 03/19/2007 ~ SECONDARY CONTAINMENT. COVERED WHEN NOT IN USE. Release Containment 03/19/2007 SECONDARY CONTAINMENT AND ABSORBANT. Clean Up PAPER TOWELS AND ABSORBANT. 03/19/2007 v1.11C 1_ 1SC.7"V UL[.:C liC: l.1VdL1UII -6- 10/10/2007 F PLAQUE ATTACK SiteID: 015-021-002904 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~NCC:1d1 ildGdLC.l~ Utility Shut-Offs S SIDE OF BLDG 03/19/2007 Fire Protec./Avail. Water 03/19/2007 SPRINKLER SYSTEM FIRE HYDRANT - PARKING AREA Building Occupancy Level 03/19/2007 20 EMPLOYEES -7- 10/10/2007 S. F PLAQUE ATTACK SiteID: 015-021-002904 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training rayc ~ riciu ivi ru~.uic ~~c Held for Future Use -8- 10/10/2007 - ~ ~`a`~- Bakersfield Fire Dept. UNIFIED PROGRAM INSPECTION CHECKLIST Enironmental Services 3 - _, - e, - - - _ ... ~ .:~ : _ - ti- 1715 Chester Ave SECTION 1 Business Plan and Inventory Program ~ Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME INSPECTION D TE INSPECTION TIME Qf~v~ ~~.e~ e t ~z3 ~ir ADDRESS PHONE No. No. of Employees ( X91 t~1 H-+'tf t,~.J _ _ _ _ _ _ __ ____ _ ___ _ _ _ Business ID Number FACILITYCONTACT 15-021- NC-r~ 11 Section 1: Business Plan and Inventory Program ^ Routine t~c;ombined ^ Joint Agency ^Mnlti-Agency ^ Complaint ^ Re-inspection C V inncel OPERATION ti COMMENTS J o \V=Vioa ^ ^ PERMIT ON HAND APPROPRIATE ^ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ ^ VISIBLE ADDRESS 2 ^ ^ CORRECT OCCUPANCY ,~ / ^ ^ VERIFICATION OF INVENTORY MATERIALS ~'[~ F,k~/L ^ ^ VERIFICATION OF QUANTITIES I } S ~1.C. ~L,~.S i r~. ~rv~ 30 GAc. i~rVNUS~ ^ ^ VERIFICATION OF LOCATION 1 ~ t ~ ^ ^ f ROPER SEGREGATION OF MATERIAL ^ ^ VERIFICATION OF MSDS AVAILABILITYE - --- - -- - -- - - --- _.... - - ---I - - - - - - - --- -- - i - -- ^ ^ ^ ^ VERIFICATION OF HAT MAT TRAINING i VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ ^ EMERGENCY PROCEDURES ADEQUATE _ -. _ _ --- ^ CONTAINERS PROPERLY LABELED i ~``,,,q~C ~~ ^ ^ HOUSEKEEPING ^ ^ FIRE PROTECTION ~ ^ ^ SITE DIAGRAM ADEQUATE & ON HANp ANY HAZARDOUS WASTE ON SITE/: YES ^ NO EXPLAIN: ~ ~ l /1(L`2, QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT (66~ ~ 3Z6-3979 ~~~C~ Inspector (Please Print) Fire Prevention tst-InlShift of Site White -Environmental Services Yellow -Station Copy a ____ _ _ M~~~_~~~.c.z Business Site Responsible Pa (Please Print) rn N O Pink -Business Copy FACILITY NAME Section 4: Hazardous Waste Generator Program ^ Routine l~ Combined ^ Joint Agency ^Multf-Agency ^ Complaint ^ Re-inspection OPERATION C V .COMMENTS Hazardous waste determination has been made EPA ID Number . Authorized for waste treatment and/or storage Reported release, fire, or explosion within I S days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondary containment provided ~C~SC ~cN~4E C'vN'iY'v~~Evr Conducts daily inspection of tanks Used oil. not contaminated with other hazardous waste Proper management of lead acid batteries including labels Proper management of used oil filters Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal ~=~ompuance v=vtoianon Inspector: ~' ^~-'~ Office of Environmental Services (661) 326-3979 White -Env. Svcs. ^~ ~ CITY OF BAKERSFIELD FIRE DEPARTMENT ~ OFFICE OF ENVIRONMENTAL SERVICES b .y UNIFIED PROGRAM INSPECTION CHECKLIST ~,`~gti 1715 Chester Ave., 3'd Floor, Bakersfield, CA 93301 ~l~c~i~c ~'~ ~~e~ INSPECTION DATE 1 ~ (.z3/°4 Pink -Business Copy EPA ID # Business Site R onsible Party '~~ EW ^ ADD 8 E R S F I D ~~R~ ABTM T ...y i ~ .. A /' o.~• HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION 200 I. FACILITY INFnRMAT10N (one form per material per building or area) .-.__ ._. Paga _ of E or DBA -Doing Business As) ame as FACILITY NA 9USINESS NA ME (S 3 M ^~ ^/ Q l L!j'~C~ f'~l 1 ~(~ 1 _ ____ 20t CHEtAICAL LOCATION ^ CHEMICAL LOCATION ( ~ [ /.~.(~ n/( L-~/~ ^ r^ , , S ~~ ~ L~-'if 1 _~ ~ ~ I ~~ Yes No J CONFIDENTIAL (EPCRA) 202 ----------~- ~,~ FACILITY ID # .-_~.:_ .. , _..._ .. ..... t~ MAP # (oPtiona4 203 GRID # (opfiortal) _ -----------~---- ~ -- ~Y ,.. ~ ~--L ~ ---......----- 11. CHEMICAL INFORMATION ---- __ _.---._....___... __ ...._- ......._ ... __. .. 205 TRADE SECRET --- ^ Yes ^ No - 206 CHEMICAL NAME /1r"j ~ ~; ~ `ice II I! Subject to EPCRA, refer to instructions ---- -°--- - -- 207--- ------------------- ---- COMMON NAME ~ EHS' ^ y~ ^ No 208 CAS # 209 •If EHS is'Yes.' all amounts below m°u be in lbs. i FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 210 ---- - - - .._._..._ . TYPE ^ D PURE ^ m MIXTURE w WAS . ~ L' . R-JJIOACTIVc . _ . y CURIES ^ Yes ^ No 212 . _ - -- - ------- 213 .. .. ._ - ----' - - .... - --_ . _ - -. PHYSICAL STATE ^ 5 SOLID ""~ LIOUID ^ g GAS 214 LARGEST CONTAINER _ .. _. . - fr- J 215 - --'_ --'- - - -- - __ FED HAZARD CATEGORIES ^ t FIRE ^ 2 REACTIVE ^ 3 PRESS JRE F:ELE~SE . 4 > :U-E H (Check all that aPD1Y) ___ EALTH ~ CHRONIC HEALTH 216 ANNUAL WASTE 217 .dAXIMUM1 ~ 278 P.VERA"E ~ 219 STATE WASTE CODE 220 AMOUNT GAILY AMOUNT DAILY AMOUNT UNITS' ~ GAL ^ d CU FT ^ Ib LBS U to TONS 221 DAYS ON SITE 222 ' If EHS, amount must be in Ibs. STORAGE CONTAINER ^ a ABOVEGROUND TANK /L]V_PLASTIGNONMETALLIC DRUM ^ i FIBER DRUM ^ m GLASS BOTTLE ^ q RAIL CAR 223 (Check all that apply) ^ b UNDERGROUND TANK ^ f CAN u j BAG ^ n PLASTIC BOTTLE ^ r OTHER ^ c TANK INSIDE BUILDING ^ g CARBOY ^ k BOX ^ o TOTE BIN ^ d STEEL DRUM ^ h SILO ^ I CYLINDER ^ p TANK'NAGON I - ----.... - -_ - --- - -- ---- - ___... _... STORAGE PRESSURE ~ AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW - - --- -.._...- - AMBIENT 22a ,_, ( STORAGE TEMPERATURE ~{,U a AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT ^ c CRYOGENIC ~\ 225 HAZARDOUS COMPONENT °loWT EHS CAS # 1 226 i 227 ^ Yes ^ No 226 229 2 230 ', 231 ^ Yes ^ No 232 233 3 ~' 234 ~ 235 i ^ Yes ^ No 236 237 _-- I .gyp 1 _ ....- _ __-. - ---._... _.._.._. .. __ .... _ 239. __.- . . _--241 .. Yes Nd 240 j 5 242 I ~ 243 ~ ^ Yes ^ No 244 245 III. SIGNATURE ~j', ~ i ` PRINT NAME 8 TITLE OF AUTHORIZED COMPANY REPRESENTATIVE ~ SIGNATURE ~ ~~ ~ - ~~ ~ ~ ~~ DATE 246 CITI~" Ot~ 13:'~tiERS1~ 1ELD OFFICE OF EN~'IROV~IENTAL SERti'ICES 171 Chester Ave., CA 93301 (661) 326-3979 ^ DELETE ^ REVISE UPCF (7/99) S:ICUPAFORMS10ES2731.TV4.wpd ~~~ ~ ~', ~ ~~ f __ _ _ _ __ ~ _ ~~~ I (--- - 1 ~_- _ _ J NOEL DOROTHEO, DM_ D _ 1491 White Lane General Dentistry Bakersfield, CA"93307 -- - {661) 827-9183 . auE ,~ .~ o ~ ~ ~~, i- JIACHANG ZHANG, DDS 1491 White Lane General Dentistry Bakersfield, CA 93307 (661) 827-9183