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HomeMy WebLinkAboutBUSINESS PLAN 5/23/2006I _~ SCOTT A WALLACE DDS/ RICHARD A ~ PARROT DDS 4801 !~I__LSON #13 U ~~ i • i + JELMINI DMD RANDY J _________________________________ SiteID: 015-021-002360 + Manager Location: 4801 WILSON RD C City BAKERSFIELD CommCode: BFD STA 07 EPA Numb: BusPhone: (661) 832-1877 Map 123 CommHaz Minimal Grid: 11A FacUnits: 1 AOV: SIC Code:8621 DunnBrad: --------- ---- --- ----------------------- Emergency Contact / Title Emergency Contact / Title RANDY J JELMINI DMD / DEBBIE MORNS / OFFICE MANAGER Business Phone: (661) 832-1877x Business Phone: (661) 832-1877x 24-Hour Phone (661) 805-0895x 24-Hour Phone (661) 834-8974x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: React Contact Phone: (661) 832-1877x MailAddr: 4801 WILSON RD C State: CA City BAKERSFIELD Zip 93309 Owner RANDY J JELMINI DMD Phone: (661) 832-1877x Address 4801 WILSON RD C State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN ( ~ /~,~ "l Q ~S ~ ~~ 5 Based on my inquiry of those individuals EN~ U J U N O ~ ZOOU responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the inforrnat~ion_ submitted and believe the information is true, ~ ` ` \ accurate, and complete. ~ - ,_ 'Z ~ __ ign itu Date ----------------------------- -1- 05/18/2006 :, i~~~ WALLACE/PARROTT DDS SiteID: 015-021-002359 Manager cfCD~ ~aa~ace BusPhone: (661) 834-5005 Location: 4801 WILSON RD B Map 123 CommHaz Minimal City BAKERSFIELD Grid: 11C FacUnits: 1 AOV: CommCode: BFD STA 07 EPA Numb: ' SIC Code:8621 DunnBrad: Emergency Contact / Title Emergency Contact / e SCOTT A WALLACE DDS / ~res~d ~t RICHARD A PARRO DDS Business Phone: (661) 834-5005x Business e: (661) 834-5005x 24-Hour Phone ( ) - x 24-H Phone ( ) - x Pager Phone ( ) - x er Phone ( ) - x Hazmat Hazards: React Contact (~'C0~'~' bl/Cu-LG7-C.e Phone: (661) 834-5005x MailAddr: 4801 WILSON RD B State: CA City BAKERSFIELD Zip 93309 Owner SCOTT WALLACE/ Phone: (661) 834-5005x Address 4801 WILSON RD B State: CA City BAKERSFIELD Zip 93309 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG H - HAZ WASTE GEN `~ b ~ BaSnd on my inquiry of those individuals respcnsi4'e for obtaining ti!q informati on, I certify under r~2rsalty rf lav,~ than I havE personally examined and am famili ar uvith the inforrr•.ation submitted anG believe the information is true accu t c ` ~~~ , ra e, and complete. ~ nn 1 V ~~~ ~ Signature 3' ~S- O"j Date -1- 02/20/2007 F WALLACE/PARROTT DDS SiteID: 015-021-002359 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP WASTE FIXER R L 10.00 GAL Min -2- 02/20/2007 -3- oa/ao/aoo~ F WALLACE/PARROTT DDS SiteID: 015-021-002359 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: DARKROOM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TWasteAmbient ~ Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 10.00 GAL 10.00 GAL HAZARDOUS COMPONENTS oWt. RS CAS# Silver No 7440224 riL'~GHKL H~ 5~J51~1~1V1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 02/20/2007 F WALLACE/PARROTT DDS SiteID: 015-021-002359 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 05/23/2006 ~ EMPLOYEES ARE ADVISED TO NOTIFY DOCTORS AND APPROPRIATE ACTION WILL BE TAKEN Employee Notif./Evacuation 05/23/2006 EMPLOYEES ARE ADVISED TO NOTIFY DOCTORS AND APPROPRIATE ACTION WILL BE TAKEN Public Notif./Evacuation Emergency Medical Plan 05/23/2006 FIRST AID WILL BE ADMISISTERED AND PERSON ADVERSLY AFFECTED WILL BE ADVISED TO SEEK MEDICAL CARE. IN MORE URGENT EMERGENCY, 911 WILL BE DIALED AND WILL SEEK APPROPRIATE EMERGENCY RESPONSE. -5- 02/20/2007 F WALLACE/PARROTT DDS SiteID: 015-021-002359 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ _, l~clcaac t1cVG111.1V11 Release Containment COVER WITH KITTY LITTER 07/11/2002 Clean Up COVER WITH KITTY LITTER 07/11/2002 Other Resource Activation -6- 02/20/2007 F WALLACE/PARROTT DDS SiteID: 015-021-002359 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ _, ,_ .~~c~.iai raac~aiua V1.111 Ly J11LL1.-V11S Fire Protec./Avail. Water tsuiiaing occupancy Level 7 ~ i 5 1-} -7- 02/20/2007 ;: ,: F WALLACE/PARROTT DDS SiteID: 015-021-002359 ~ Fast Format ~ ~"Training Overall Site ~ _, ~~u~iv~r cc 110.111111y rayC ~ nCiu .~~i ruLUiC v5C RGlu lvl rut, uLC V5C -8- 02/20/2007 UNIFIED PROGRAM INSPECTION CHECKLIST= ~~ir .SECTION 1: Business Plan and Inventory Program ~ ~ ~r,. ~ rt 1n 00~ r+ o . fi ~~ .~ BAKERSFIEILD FIRE DEPT Prevention Services 900 Trtuctun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: .(661) 872-2171 FACILITY NAME A '~ P~ i.t~~c,E ~ - S NSPEgTION DATE 3/ /s/ r~ NSPECTION TIME ADDRESS ~ v~ ~ ~ I , rO ~ ~~ ~ ~ HONE NO. ~~ O OF EMPLOYEES FACILITY CONTACT USINESS ID NUMBER 15-021- ~~~ 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 BUSIYI@SS 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 HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ ^ EMERGENCY PROCEDURES ADEQUATE CONTAINERS PROPERLY LABELED if~i~ L ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE 8 ON HAND ANY HAZARDOUS.WASTE ON SITE? ~ES ^ NO EXPLAIN: ~ ~~~ G -"~') ~C ~ 2~ - -------- - ------ - QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL U8 AT (881) 328-3979 ,~~^ Inspector (Please Print) Fire Prevention / 1" In / Shift of Site/Station k ~ ss Site/School Site Responsible Party (Please Print) White -Prevention Services Yellow - Station Copy pink - 9uaineas Copy FD2049 (Rev. 02/05) ~~ - ~~' T~`~ CITY OF BAKERSFIELD FIRE DEPARTMENT ~~ b~ OFFICE OF ENVIRONMENTAL SERVICES ~~' , • ~~ UNIFIED PROGRAM INSPECTION CHECKLIST ?~ak~,`~ga~' 1715 Chester Ave., 3~d Floor, Bakersfield, CA 93301 FACILITY NAME Wt~t't--Pc.~ l ~~ ,~~5 Section 4: Hazardous Waste Generator Program ^ Routine '~ Combined ^ Joint Agency INSPECTION DATE "~ ! IS ~ 4' EPA ID # ~k~ ^" ~ T ^Multi-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA 1D Number ~~'Y~ ~5"~" Authorized for waste treatment and/or storage ,s }td~j i cQ „~ 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 leaking Containers are compatible with the hazardous waste ' Containers aze kept closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line /~/ l~ Secondary containment provided Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels N Proper management of used oil filters ~~~ Transports hazazdous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years Retains hazardous waste analysis for 3 years ~- ~°~ Sal ~~r, Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal ~,=~,ompnance v= v totanon Inspector:~,~ ~'~'~l "J ~~ Office of Environmental Services (661)) 32 White -Env. Svcs. Pink -Business Copy ' i7[-CAL siness Site Responsible Party .. ''--. OFFICE HOURS BY APPOINTMENT A. PARROTT D.D.S. INCORPORATED 4801 WILSON ROAD, SUITE B , BAKERSFIELD, CA 93309 PHONE (661) 834-5005 -- -. - - - '- "<>, JM -,------ D.D.S. I I [661] 834-5005 4801 WILSON ROAD · SUITE B BAKERSFIELD. CA 93309 :,; /- SCOTT WALLACE/RICHARD4ItRROTT,DDS e SiteID: 015-021-002359 Manager Location: 4801 WILSON RD B City BAKERSFIELD -\ ~\'l;~ BusPhone: Map : 123 Grid: 11C (661) 834-5005 CommHaz : FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 07 EPA Numb: SIC Code:8621 DunnBrad: Emergency Contact SCOTT A WALLACE Business Phone: 24-Hour Phone Pager Phone / Title / DDS (661) 834-5005x () x () x Emergency Contact / Title RICHARD A PARROTT / DDS Business Phone: (661) 834-5005x 24 -Hour Phone : () x Pager Phone : () X Hazmat Hazards: React Owner Address City WALLACE/PARROTT, DDS 4801 WILSON RD B BAKERSFIELD Phone: (661) 834-5005x State: CA Zip 93309 Phone: (661) 834-5005x State: CA Zip 93309 Contact : MailAddr: 4801 WILSON RD B City BAKERSFIELD Period Preparer: Certif'd: ParcelNo: to TotalASTs: TotalUSTs: = RSs: No Gal Gal Emergency Directives: I, I<,~ ~'íf1)ð hsU'sby C~Ii¡fy ~h~~ ~ have (TVP3 or !rint nama) r~iewed the atiachsd haæalrdous m~tsriai$ mal tags- ment plan ~or4 /)/tc..utrJ:$ ""añ©1 tMt it ~ong with (illÐme of Businass) ~ny c©IT~dion$ ©on~ituts (Q1 c©mpl~~ and <OOü'y®d man- agsmsrot plan ~108' (V\~ ~acility. /új17)J ·DÐlø' -1- 10/21/2003 . CITY OF BAKERSFIELJA OFftCE OF ENVIRONMENTAL ~VICES 1715 Chester Ave., CA 93301 (661) 326-3979 BUSINESS OWNER I OPERATOR IDENTIFICATION FACILITY INFORMATION Page Of _____0 _______. FACILITY ID # I. FACILITY IDENTIFICATION Year Beginning 100 i Year Ending i 3 i BUSINESS PHONE : «é, <0 \ j 83 L.( - 50aS 101 ---102" 103 Q.J. Sv-.'{ <::- ß ._--~ ~~~ CITY ß", I.c:.u-..+c ~ \ á , J 104 CA I ZIP 933'"0'7 106 I SIC CODE I (4 Digit #)_ 105 DUN& BRADSTREET ~5 107 3(,.3-0'14 ß' -- '--'-- COUNTY \( er "- OPERATOR NAME R',,",~d 108 PArraIT' DOS Is,,,:,,:, A W411A...... OOj . ¡." ~':~';\~,ê" ';;ê'i':c:"~:~~>;:",( , . ':'~'<-;-.-""'. < ,; '"" _ ,./;' "<.<; ~, 1" v {" ;:;:: r " ..,' 'i ";~;\"/"';A'F;;}i '" n;?\OWN-ËR~NF9RM~í]è)t~- ,;.'¿' .'.,., 109 I OPERATOR PHONE bb/ 63'i - sc::cs, 110 ' ':;,¡i¡:gì ':;;~t~/· , ,', : OWNER NAME R~"'rc\. A pAJ'r()\I DD,) /t;",<>rr A i I : OWNER MAILING ADDRESS tf8c\ WI b~ cl '5UL ~""- ß 111 OWNER PHONE (~611 B3'i - Soo<., 112 . 113 . 114 STATE C.A 115 ZIP c¡ 330 '7 . ~~~JÌ:~i~~~~~MÎ~E~2~!ÎS];;¡!r~~¿~~~t;~;~!N:;~;41;~;¡¡~;; '.", ' I -1 I ¡ CONTACT NAME "5"''CTT A_ ~\IA<Q 0 ! CONTACT MAILING : ADDRESS 4'60\ W. s..... (.(c! , i CITY ßA~...ç.e;.l d., '." .' ,.. _ . .,. ".. .'" , ...' , " .,120 STAT~ C4 ZIP Q3þj I' NAME 123 NAME ./ 11. f ^/I ? (. "" T' __,. \<-V-) 11A'-'Z. lJ".Jj 117 CONTACT PHONE (t'óbl) 6"3<./- .$C05 118 119 ..¡en, ß 122 , i ¡ 129 125 TITLE V v<-{L tJ.r b{,,/ e:,~ - SO~:;, 126 BUSINESS PHONE (, b\ 3 - SD':::>':> bE:.l ~alj -O-Z$C 127 24-HOUR PHONE ( bbr "b S - q <{ b '-I 130 131 ~4-HOUR PHONE ! PAGER # NIA i . ~ i ! ^-) ",..: '.; -f:~- ~-< ' , 132 '::J'<;'-~ ~ < ',-~, 128 I PAGER # £(" I ~ 2.1 i;;;U~/:<~":~,:;:~,~~;.Y;,i)G~Bful~IS~!ION,:.:.."·" .', .,-','. 133 f.:::> 2 ( ¥-;'<'-'-, ~"-' "':'-- '" : ,:; :.~:;};;r'J·, -:;:~ '-',,' ?<"__ :.i.~~ __. ,,", . <, ~'" i Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined ~~nd am familiar with the information submitted in this inventory and believe the information is true, accurate, and complete. . SIGNATURE OF OWNER/OPERATOR DATE 134 NAME OF DOCUMENT PREPARER 135 /~ 137 NAMES OF OWNER/OPERATO (print) 5,,'=>,...- 4/ W' '"I' (,q......, ODS 136 G:, - IS -0 ~ cSt...<:,;,T TITLE OF OWNER/OPERATOR . \r-ÍA \ \.A<..e... 00.5 V'I.Ã...- Pr~ ~ UPCF (7/99) S:\CUPAFORMS\OES2730.TV4.wpd e CITY OF BAKERSFIEIa OFFICE OF ENVIRONMENTAL SlRVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION )~~~EW 200 DADD D DELETE D REVISE ,'1. FACII.,.ITY INFORMATION (one form per material per building or area) Page of 3 BUSINESS NAME (Same as FACiliTY NAME or DBA - Doing Business As) !,. PA-rroTT 00':> ~ ,.-Í<\\V\'-'2. ()O~ ~L.~ , ck.>J , CHEMICAL lOCATION 2011 CHEMICAL LOCATION ! CONFIDENTIAL (EPCRA) 203 GRID # (optional) FACILITY ID # 1 MAP # (optional) , '-,,' /, ,-' :;,;, II. CHEMICAL INFORMATION , 205 ! TRADE SECRET 0 ~ Yes 'r'NO 206 If Subject to EPCRA, refer to instructions ¡ I . I . , ~.;, . ,ý CHEMICAL NAME WAS ,e... .-Çd, e r o Yes ~ No 202 204 COMMON NAME - .-----------"=". 207 i EHS' I, 0 Yes 0 No 208 , , 1 209 "If EHS is'Y os, . all amounts below must be in Ibs. '. WA').C-. f\",~,... CAS # 210 FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) ! TYPE ~ w WASTE o Yes ¡2\1 No 215 o m MIXTURE o P PURE 211 RADIOACTIVE 212 CURIES 213 PHYSICAL STATE CÎI LIQUID LARGEST CONTAINER .<;; 94 \ o g GAS o s SOLID 214 FED HAZARD CATEGORIES (Check all that apply) ANNUAL WASTE AMOUNT o 4 ACUTE HEALTH o 5 CHRONIC HEALTH 01 FIRE o 2 REACTIVE o 3 PRESSURE RELEASE 218 II' AVERAGE , DAILY AMOUNT . MAXIMUM DAILY AMOUNT 10 07..:'>. p(gaGAL OdCUFT . II EHS. amount must be in Ibs, 217 10 D-z.. S )roc:\.......d b a 9AL o Ib LBS tJ tn TONS UNITS' STORAGE CONTAINER (Check a" that apply) o i FIBER DRUM OJ BAG Ok BOX o I CYLINDER o m GLASS BOTTLE ø..n PLASTIC BOTTLE o 0 TOTE BIN o P TANK WAGON o a ABOVEGROUND TANK o b UNDERGROUND TANK o c TANK INSIDE BUilDING o d STEEL DRUM o e PLASTIC/NONMETALLIC DRUM 01 CAN o 9 CARBOY o h SILO STORAGE PRESSURE J& a AMBIENT o aa ABOVE AMBIENT o ba BELOW AMBIENT STORAGE TEMPERATURE o ba BELOW AMBIENT IKl a AMBIENT o aa ABOVE AMBIENT 216 219 ! STATE WASTE CODE 220 i 221 i DAYS ON SITE 222 : '3,=>S S"""'-~ """'\V'\A\ o q RAil CAR o r OTHER , 223 224 o c CRYOGENIC 225 227 I 0 Yes 0 No 228 1 , 226 230 234 238 242 231 o Yes 0 No 232 235 o Yes 0 No 236 239 o Yes 0 No 240 243 o Yes 0 No 244 229 233 237 241 245 ;)t/~~ !:;::ffi!;¡~;i:;>t»f;:::;{~!;' IGNATURE)"·/7:: ..... ~:,,:¡¡~,,:1~·;:/~f:t1·fë+" ,::.,~;;. .---Ç~c?~ .~ 0- J'S-O-z... UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd -" e e CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATEIDALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. 5. You may-also-attach Business,Owner / OperatoruFonn-and Chemical-Description Fonn(s) to the front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA I BUSINESS NAME: PArr'Cl'\ DDS ~ WA\\AUZ- OD~ T"" LOCATION: 460\ \,J,\~~ )\á..S'..h\C.- ß ß.a\.:..Cr",~'e.\d CA "13304 MAILING ADDRESS: 54""- CITY: ßt:\l.<.crs-\,e..\ ~ STATE: U\ ZIP: <=f 33oO¡PHONE: (~I) 8~l{-'SoOS PRIMARY ACTIVITY: De^'\s~'f OWNER: R.'<...~Ar- à ( A P/.W'rOO C)û~ '¡ s(~tT A- \...tc¡ 1\",,\.12 ¡ODS PHONE: oSA--e AS " - MAILING ADDRESS: - ~ ---.- - - -=>A""c A'> .A-~ov~ - - -- -.. - -- EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE i\>r~s _ 1ó6,( 634 -SaCS ,-$9- 025D V,'-'2- ~r...~ 6bl <9, 3 '( - S 00 ') (Qb~- 9'ib Lf 1. X:<\<-~d A _ \)ANû0. Do~ 2. S<.c.'~ A \--lL\ ltA.... Oùs 1 " e e HAZARDOUSMATEmALS~AGEMENTPLAN SECTION II.I: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: wh.,"" t,1'V" lS b06'^9 tI¿d.~d -ro V.l'-'~ ~ (.e-..ÎA'....c..r WI1'V\. .....>c.J {''II'c..r \'5 ei'\""-'''''-d. -for )~b &>t- -sp'llAJ" B. EMPLOYEE AND AGENCY NOTIFICATION: e""p'oyee.~ Are Ad...,sc..á "'" ':"o"f, Dr> J%^-d Aj1()V0Pt'A11:. ftL'I<h \,.J,II b( ''''Il:..., C. ENVIRONMENTAL RESPONSE MANAGEMENT: -"""4ßr'A\ VIII \o~ p,~L~pr¢'l,:,> I/\ec.-6 lei ,\,c.et'''''''cl .J~L,Lr-7 D. EMERGENCY MEDICAL PLAN: .f.,." A-J IN, I \ b~ pá"",^,<,TV'<-cI p"d f""...... ..,.à~. ty A.f'¡;"(.:n...J fo..r Î'1..e. ^'\A-.v-,,.,I will 'a... A.d."", ,,-.t ro soce..l ""'...<!.'-<\ \ <..Ar~ _ ""I f""\ "'^<:>- ~ ...;,.. .JV\ r c.-r<o)", ..~s "11\ ,....,1\ \,... ó""lLJ I\-> "'"' I \ \ S~c"'-- ....f{'tO~/v4TL ~"" 9 rofÞ"S<... 2 ~ ... e e HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION B.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: eJ.,q\ (~^~'''-Cr-- for- \~'> 64-'(1 I A--^'\ B. RELEASE CONTAINMENT AND/OR MITIGATION:. Ct)..JV'" \oN I~ (.AT" t............ -- -. - ~ - '"'--.--- - ----=...--"""'-------.-,.---=-~ - -""'- ---" -~-- - - - - -- - - ------ - - - -- C. CLEAN-UP AND RECOVERY PROCEDURES: é::>....~ v-J ~ <.AT"" l. \tV' UTILITY SHUT -OFFS (LOCATION OF SHUT -OFFS AT YOUR FACILITY) -S'w (o""c.-- of b....,,\c!v'" 11 NATURAL GAS/PROP ANE: ELECTRICAL: fù>~ bo-¡: - WÂTER:-- ~\-?h-~-~,"~ - Q...)(~- --"~c: ~C'~Q;'\ SPECIAL: IV I A- LOCK BOX:' YE~ - --~-- --- ------- IF YES, LOCATION: PRIV A TE FIRE PROTECTION/W A TER AVAILABILITY A. PRIVATE FIRE PROTECTION: A\Ar"" -s..,~T"" B. WATER AVAILABILITY (FIRE HYDRANT): \r-JI\':>Ov'\ A-^-d -:JT\-"c.:. (,,,,- ~"D"","- of7-1l) 3 e e HAZARDOUS MATEIDALS MANAGEMENT PLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: \ \ MATERIAL SAFETY DATA SHEETS ON FILE: 'k ~ BRIEF SUMMARY OF TRAINING PROGRAM: Ye.s CERTIFICATION ~, I, s'-"'.....-. ~llA'-'2- CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIY. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. ~5 SIGNATURE ÐOs V I-<..e- \),~"> TITLE HAZ MAT MNGMNT PLAN Ii. INSTRUC 4 b- \ S-O <... DATE hr-e,. (' 's F = ("--J.\~t>,", ì ~\I"~), AÇ.\"'''' , ¡/yd,~\ " .r\.J61 WAIl' '\<- f"\ . i L ,', ì I, ¡ " ~ : ~ ; "j 0' f .< j .. :':-i ~ Z , , ð<î ~,~ ' , ~~Y";! 1~ I I i 1 I i ' ! ! ' ¡ ..(. SV.v 1\!1)r{ / VJ 1 Lt- air. ?iJ\'e1L-1 c.. 'D,.{~ ' D \A~'¡-A",", -.. '.-'" y 0"< ' ~,.,'", .,:, Gj)',\..l,' . ._,' -. _-V~l . ".' ,", ..__n. ,,-,,-,,"..," . @' , ""- 1- ',' , - , .. . -,-- ,OX " ,',' ,'" . GiJ" . .. . ". -. . .,.- . ,... . ".-' . . -. . " ,. ., "-'.' .... .'~::::' .' ,.:,.: '.' -. ," n: .. .~ .... .. ..;:;":"'" - _.W,' "',', . ._-~",...:-.:..._.:,~.;,'-<.:.,_:-.~.,:::-:... : ..... . -. .. .--.-. -, " lTh0.,....,....,'; ..'"..,---. >:-:-:::::;~ :,'-;~f:~: :-:::~~':>':~,' , . f,. _ _.. . - ._. __',.n_ I ,{ ¡ ,¡¡,:m::'''\~-''-: ;, oJ ,""..;,.... " .. I ,rf,v;i,f: h..A '\,1./ ..i~-'l.'f",~\," \.. ;t,;f~ \ "'·',r.l, I .:'," ,c '<1~ I ", ~~ ,:"rD,'~_""'''' ::!····v· '"' ',I, I 'f; , (It-I 'íL0 I H20 \ ~\.,...... .1:\ AN'^, -, off'........ _;S'f'ó.c.,..,,; 1..._ ~t,---, Áß vj\t' ~Q " f)¡-II t-^ I Vv ~ C!..t..-o'SeT "5 íV L P¡ f.t!!. --- /S\ = 5£vJ-c~ @ ~ !fIR- ¿';JÏ)Jí]i);.)¡.J(, @ - W/k'~fL & - (lit> WASTe- -Ç')£er Ùn\IT'f sbv\ cffs èn:!! 00 ~ t;) 0 :I: A0::t:Þ m~ :IJ ~~:þC :!)bjo :Þ µ!o=e° oZ:þ" (-,::D,:Þ »O,:IJ co E; :Þ :IJ w- (") 0 ~cnm-i <p s- ~ .þ.- C- ~mo C wCD~C (f)o o~ e . ," n" 0 "~;." (Lf>'--.J\ ,,--- " P 3 {/ ~ ' 1&'_ 0'.. _ ' I ..~. ______1 <ë~, ~ ,c:: -:~. ~ ~.. ." -', .-. < '-.r --~'::-"-':. -- :- '-.- . - - c,;~ "., p..,,<'1 .~g':'7Ò1:0"· '..,'-,.:"., '·">:1 -;..~'.-:;_:~" . .>~':.\ A I;"-':<>'~"~' :~ -,'"'......,'-" 'VV '..,',' ",,,,,,:--::::.. ,,' '.;' ."':,.':,, '\ . ".. ~". .. :.'" :,.:...,:::".;.;",>:" ..'::.' ," f /fU\ ~ ; \oo~ @. ~!~,.:;~! . ':,' ~~ 1--.1- ,..b,i\."... ,\ .. r "'] :...;,!,. _: . . ::;:¡:i~~ ·F:~~.:5~;;, ~.{\ ,. ::.:'<';<~-;~:~ ¡ e 1~\J' \'\(1... \..J ,.' (It ùfr t ru\5DS \ == 'J1O ~ Aq£ LDC-1"íT1 0;) ~ ::; t/It.C é:/-.'77¡J (p u.. I S~.¿~ "'- Co¡J7/:,¡/J.s é.i:;>-cr.4 1;-) ~ ;/ fì 21:JI-¿..!:;. ð·.J.s. t I.)... Ð"-11 (11 <-..s . £s '12 hÓ() . CITY OF BAKERSFIEI.D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 6'! .¡Jfft1 flfVlOI SS()o ( ~lCL\A(U) A, PARRo1T OOS FACILITY NAME . ~<::oTí A. WA~ PI'S ADDRESS 4~o 1 tNU_SðN \2,.') ~ B FACILITY CONTACT INSPECTION TIME INSPECTION DATE f:,-¡ ( 10'1. PHONE NO. g') 4 _Çöð~ BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES 1:23 - II - t!.- 7 gb~1 Section 1: Business Plan and Inventory Program 1fy' o Routine ~ombined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERA TION C V COMMENTS Appropriate pennit on hand ¡VC...."J P~tr S'lrt Business plan contact infonnation accurate Visible address Correct occupancy Verification of inventory materials ~TE Fr k.C~ Verification of quantities Ç"'6AL 11>1.1.\-~ / 0ó 6A-....~ Verification of location IN<;d) (3 ()~ (ùtt.. 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 C=Compliance V=Violation Any hazardous waste on site?: c1Ves 0 No Explain: /A.J'A:s~ r(Dú?L Questions regarding this inspection? Please call us at (661) 326-3979 While - Env, Svcs. Yellow - Station Copy Pink - Business Copy Inspector: WINes ;,1'\-, .,..A-' ..", .',' '. ES t!2&ÓO ._ CITY OF BAKERSFIEI..D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd f'loor, Bakersfield, CA 93301 1fj116/ ! fI frl Ú , 1 55C>O ( ~tCIJAfU) A. PA~"\""'F D->'S FACILITY NAME "'5.<:o"v"" A. WAt..f...~é3 f)l\s ADDRESS 4~o U WIt_SÒN 1l.t:\ ~(;. ß FACILITY CONTACT INSPECTION TIME INSPECTION DATE ' 5: I f 101- PHONE NO. g~.4 _ çoo~ BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES /23 ' 1/ - e. 7 8"b)/ Section 1: Business Plan and Inventory Program 1Þ , I , , o Routine ~Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V ÇOMMENTS Appropriate pennit on hand f\K.~ ?Gt.M. r S"1'T'f'" Business plan contact infonnation accurate Visible address ;;, Correct occupanc}:. , Veri fication of inventory materials W>A-r:;ït: Fv~c""'t.. Verification of quantities ~ ØA-L VJ.14- ¡f. / 6::ö 6Ab~ Veri fication of location ,1\1 S d> c= ()~ ~. 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 , C=Compliance V=Violation Any hazardous waste on site?: Explain: ~%. r/\\.Ctf'L. !:1Ves 0 No White - Env, Svcs. Yellow - Station Copy Pink - Business Copy C)øA9,Ieu: (!atk.'71 ~usiness Site Responsible Party W I/\/::::-c Inspector: \",~ Questions regarding this inspection? Please call us at (~61)..3.26-3979 ; · CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 Section 4: Hazardous Waste Generator Program INSPECTION DATE J/ I\- S/ t I<n.- FACILITY NAME 'þ/<-S f'A.R.RðïT t(: WÁLt.ð.c.£ DDS EP AID # o Routine ø.. Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Hazardous waste determination has been made Au (~.5 O~ EP A ID Number (Phone: 916-324-1781 to obtain EP A ID #) Authorized for waste treatment and/or storage 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 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 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 trom land disposal C=Compliance V=Violation Pink - Business Copy Inspector: Office of Environmental Services (661) 326-3979 White - Env. Svcs, iNl~