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Home My WebLink AboutBUSINESS PLAN 7/11/2007 ('IABe FAMILY DENTISTRY l 2400 WIBLE RD 12 --.-- - -.-------- -- --'-_._--_._~-- I / I I I I I I I I \ "11 I I ii , II Ii II I, I \ I 1\ J- - --- -_.- - -- - ,-- . ...\ "~ . ':~ ABC FAMILY DENTISTRY SiteID: 015-021-002911 Manager : DAT TRAN Location: 2400 WIBLE RD 12 City BAKERSFIELD BusPhone: Map : 123 Grid: lIB (661) 833-1533 CommHaz : Minimal FacUnits: 1 AOV: CommCode: BFD STA 07 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title DAT TRAN DDS / OWNER / Business Phone: (661) 833-1533x Business Phone: ( ) - ~) 24-Hour Phone : (661) 932-1959x 24-Hour Phone : (bE,' ) Oil 2.. - 81Lf Pager Phone : (661) 932-1959x Pager Phone : ( ) s... -.(,.. .'" x Hazmat Hazards: React Period : Preparer: Certif'd: ParcelNo: to Phone: (661) 833-1533x State: CA Zip : 93304 Phone: (661) 833-1533x State: CA Zip : 93304 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Contact : DAT TRAN MailAddr: 2400 WIBLE RD 12 City : BAKERSFIELD Owner Address City DAT TRAN DDS : 2400 WIBLE RD 12 : BAKERSFIELD Emergency Directives: PROG H - HAZ WASTE GEN ENTO JUL 18 tOUr Based on my inquiry of .those i.ndividua.ls responsible for obtaining the information. I certify under penalty of law that '. have person<l:\ly examined and am familiar ":'11th the !nfo~matlon submitted and believe the mformatlon IS true, accurate, and complete. ~~. I I \ -1- 06/29/2007 " 'i': F ABC FAMILY DENTISTRY f= Hazmat Inventory f== MCP+DailyMax Order SiteID: 015-021-002911 , By Facility Unit 1 Fixed Containers at Site 9 IspecHazlEPA Hazards I Frm I DailyMax IUnitlMCP R L 0.25 GAL Min Hazmat Common Name... WASTE FIXER -2- 06/29/2007 '1 ~, -3- 06/29/2007 F ABC FAMILY DENTISTRY f= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME WASTE FIXER SiteID: 015-021-002911 9 Facility Unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit NE CRNR OF BLDG Map: Grid: CAS # STATE - TYPE Liquid Waste PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 5.00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 0.25 GAL Daily Average 0.25 GAL %Wt. I Silver HAZARDOUS COMPONENTS ~ CAS # I 7440224 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 06/29/2007 .. SiteID: 015-021-002911 , Fast Format 9 Overall Site 9 04/05/2007 F ABC FAMILY DENTISTRY I p= Notif./Evacuation/Medical Agency Notification PHONE LIST AND 911 Employee Notif./Evacuation 04/05/2007 VERBAL NOTIFICATION, EVACUATE OUT FRONT DOOR AND BACK EMERGENCY EXIT. Public Notif./Evacuation 04/05/2007 VERBAL NOTIFICATION, EVACUATION OUT FRONT DOOR AND BACK EMERGENCY EXIT. Emergency Medical Plan -5- 06/29/2007 'i SiteID: 015-021-002911 9 Fast Format 1 Overall Site 1 F ABC FAMILY DENTISTRY I p= Mitigation/prevent/Abatemt Release Prevention Release Containment 04/04/2007 SELF-CONTAINMENT Clean Up Other Resource Activation -6- 06/29/2007 ~'i !..' SiteID: 015-021-002911 9 Fast Format 9 Overall Site 9 F ABC FAMILY DENTISTRY I p= Site Emergency Factors Special Hazards Utility Shut-Offs 04/05/2007 GAS - NE SIDE OF BLDG ELECTRICAL - NE SIDE OF BLDG WATER - SE CRNR OF BLDG Fire Protec./Avail. Water 04/05/2007 SPRINKLER SYSTEM AND FIRE EXTINGUISHERS FIRE HYDRANT - S SIDE OF BLDG ON WILSON Building Occupancy Level 04/04/2007 1 LEVEL -7- 06/29/2007 ~ ;r '. ; F ABC FAMILY DENTISTRY I f= Training Employee Training SiteID: 015-021-002911 9 Fast Format 9 Overall Site 9 04/05/2007 BRIEF SUMMARY OF TRAINING PROGRAM: OSHA COMPLIANCE TRAINING Page 2 Held for Future Use Held for Future Use -8- 06/29/2007 .~ Design, !nstaliation, Inspection and Repair of Fire Sprinkler 1]') Coif! ~<'f,)Mc;",Il~(f~r((jl U::JC..I.;,\I.i",u ,0lJ U",_,i.J,-"., [So . r"!:~'-..; ,<'Y' ;~--" ..1 'r3 .0\\1'.",)[ C\fl)(oL{;' (,) [f.)(~1C!?:;DHo@ @[j'\iD'\V7G?i DATE: January. 2006 We herewith enclose a copy of an automatic fire sprinkler system check report for the following facility: MOR Furniture 2204 & 2400 Wible Road ~akersfield, CA 93304 to the party checked below: Owner: MOR Furniture 2204 Wible Road Bakersfield, CA 93304 ~ Fire Dept: Bakersfield City Fire Department Fire Prevention Division 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 Thank You RLH Fire Protection File: 7227 cc: Buzz Oates Management Co. 2385 Arch Airport Rd. Suite 100 Stockton, CA 95206 Attn: Chris Porter fRi [L [HI fF-:: [j [( (~ [[2) [f' @ 1]; @ (Q: 1]; tl (Q) Hi1 310 30th Street Bakersfield, CA 93301 Voice 661.322.9344 Fax 661.322.6816 License# 777717 "\ <' i (1S 1:(:;1! 1;3 tiC)!")! and {)"f FirE~ [ID,~J ~ (~~ [?S?)Ho (f) n 0il O,0~i7@0"OUD((D'J'@ lJ:Ji'~l@oHo(~~ @[iJ@';'i]@ January 26, 2006 LIST OF DEFICIENCIES #7227 Mor Furniture 2204 Wible Road Bakersfield, CA 93304 1. Back Storage Room: Head not free from obstruction: Insulation needs to be restapled. ~i::R lb a='J IF 0 IT' @ ~9) If (Q)'~ @ ~ 'Q: 0 (Q) ]1) 310 30th Street Bakersfield, CA 93301 Voice 661.322.9344 Fax 661.322.6816 License# 777717 - -~ Des]gn, Installation, Inspection and Repair of Fire Sprinkler Systems ;< []~ ') <,;,-, ~ '0 rr'c~ol'r':O~ /ie;,;O -.r r...)c"" ,,(r;) I ,~) "l,:.':", (Oi ._~ :-s.....J." _,~ ,_ L "'-.:::;.:'_ \,'::W n " Lc"OWCf,I[j'ITiJi.1C0[j'(}~) [pJ [~K!~~ lHm C!.3 G'8 [f'(iJ.i\V7 CD SYSTEM CHECK REPORT FORM WET PIPE SPRINKLER SYSTEMS (Title 19, Sec. 904.5) Facility: MOR Furniture Address: 2204 Wible Road Bakersfield, CA 93304 Reviewer: R.- Gentry Notes: Date: 01/26/06 MC#: 7227 Last 5 Year Service 08/10/2002 FIRE DEPARTMENT CONNECTION YES N/A NO 1. Are fire department connections free of obstructions? X 2. Are fire department connections in good condition? X 3. Are couplings free and rotate freely? X 4. Do clappers move freely and close completely? X 5. Are gaskets in place and in good condition? X 6. Are caps in place? X 7. Are inlets identified with a sign? X CONTROL VALVES 1. Are control valves free of leaks? X 2. Are control valves secured in open position? X 3. Are control valves free of visible or ext. obstruction? X GAUGES 1. Are gauges in good condition? X 2, Are gauge valves turned on? X 3. System pressure? Record 80 P.S,I. X 4. Supply pressure? Record P.S.I. X RISER 1. Is riser free of leaks? X 2. Is riser bracing properly secured and free of damage? X 3. Is riser free of visible or exterior damage? X 4. Water motor and gong test satisfactory? Electric Bell X PIPING 1. Is accessible piping free of damage? X 2. Is piping free of visible or exterior obstructions? X SPRINKLER HEADS 1. Are sprinkler heads free of leaks and corrosion? X 2. Is all storage at least 18" below deflectors? X 3. Are sprinklers installed in proper position? X 4. Are extra heads and proper orifice wrench available? X 5. Are extra heads of the proper size and temperature? X Water Pressure City WATER FLOW TEST PSI Tank PSI Fire Pump PSI T t p' L t d S' p' P B ~ FI P P Aft es Ipe oca e lZe Ipe ressure e ore ow ress ress. er Riser 2" 80 55 65 IXi Ll~, LnJ Lr [] [, (Q) 1~c!.J [J @ 'It (Q) cg; 'It [] (Q) [i'i] ~;-:':';;.l,;:;;::.':;',':-:;;.','!;;'!:-:'T:':!.';r.-::;':'!;';1.'r!:;::Z::~'.'::;.~:~~~:?i:;::.';::::':, _:':'-!!:'_";~,::":?"';."_',':>::~'::":!r.'r;;':',".'!;",:;:_W~;_~,:::;_::,._~::.>~_,!,:,_-::_':"Wt'~~:,":":': .........................................~.....,..................................................................... ;..:::;'!;J.':za;:!!;-;:s,'f,y:::;Z~:;q;:":I:~:.~.!:;::.::~:D:!:}'i:;~!:::::,':;::...,,:::~,,':,lY:i:::i0; ::iH:~'g;"5.1:~"!!!;':;':'ii:':r~'r'!:::::::~::.:.::::~',~!:E:';: I::\.:"!.';:.':~:_':'::?,'!,.::;;,;'::i."!:HE:':;Y;:.::!::.~?:f~.E:':-:::E:':~!!g:::::;:.':u;~"Z!:!::~':t::.'t::::':::::::'!,::':.:.~ 310 30th Street Bakersfield, CA 93301 Voice 661.322.9344 Fax 661,322.6816 License# 777717 '); Design, Installation, Inspection and Repair of Flre Sprinkler ,~, [IDe[\ r!0.(fJ)[J'@ffo@Dcg] [bO'Y7C~D [JTFiJ\J(~~}[JJ@ [p[~{}C;:;Om@ (X?:I [J\!D'Y7G~) SYSTEM CHECK REPORT FORM WET PIPE SPRINKLER SYSTEMS (Title 19, Sec. 904.5) Facility: MOR Furniture Address: 2200 Wible Road Bakersfield, CA 93304 Reviewer: R. Gentry Notes: Date: 01/26/06 MC#: 7227 FIRE DEPARTMENT CONNECTION YES N/A NO 1. Are fire department connections free of obstructions? X 2. Are fire department connections in good condition? X 3. Are couplings fre.e and rotate freelv? X 4. Do clappers move freely and close completelv? X 5. Are gaskets in place and in good condition? X 6. Are caps in place? X 7. Are inlets identified with a sign? . X CONTROL VALVES 1. Are control valves free of leaks? X 2. Are control valves secured in open position? X 3. Are. control valves free of visible or ext. obstruction? X GAUGES 1. Are gauges in good condition? X 2. Are gauge valves turned on? X 3. System pressure? Record 75 P.S.I. X 4. Supply pressure? Record P.S.I. X RISER 1. Is riser free of leaks? X 2. Is riser bracing properly secured and free of damage? X 3. Is riser free of visible or exterior damage? X 4. Water motor and (gong) test satisfactory? Electric X PIPING 1. Is accessible piping free of damage? X 2, Is piping free of visible or exterior obstructions? X SPRINKLER HEADS 1. Are sprinkler heads free ofleaks and corrosion? X 2. Is all storage at least 18" below deflectors? X 3. Are sprinklers installed in proper position? X 4. Are extra heads and proper orifice wrench available? X 5. Are extra heads of the proper size and temperature? X Water Pressure City WATER FLOW TEST PSI Tank PSI Fire Pump PSI T P' L d est ipe ocate Size Pipe Pressure Before Flow Press Press. After Riser 2" 75 55 65 [is; [1 [U] 11.1 _=., n [F' ti [J @ [[2) [J @ i.t @ cg: 1t tl (QHIi! 310 30th Street Bakersfield, CA 93301 Voice 661.322.9344 Fax 661.322.6816 License# 777717 ,. ~..- '~ ~ '7 .- 1''':-' -..;-~- ~~ CLINICA SIERRA VISTA Lf~ }~lo SiteID: 015-021-002423 Manager PAM MILLER Location: 2400 WIBLE RD 14 City BAKERSFIELD CommCode: BFD STA 07 EPA Numb: BusPhone: Map : 123 Grid: lIB (661) 835-3050 CommHaz : Minimal FacUnits: 1 AOV: SIC Code: DunnBrad: Emergency Contact PAM MILLER Business Phone: 24-Hour phone Pager Phone / Title / ADMINISTRATOR (661) 835-3050x () x () x Hazmat Hazards: Contact: CAROLINA CRUZ MailAddr: 2400 WIBLE RD 14 City BAKERSFILED Owner Address City CLINICA SIERRA VISTA 1430 TRUXTUN AVE 400 BAKERSFILED Period Preparer: Certif'd: ParcelNo: "to Emergency Directives: PROG H - HAZ WASTE GEN ~~(t Based on my inquiry of those i.ndividua.ls responsible for obtaining the information, I certify under penalty of law that I have person~lIy examined an m familiar with the mfo~matlOn submitted a tl elieve the informatl n IS true, accurate. n c plete. Emergency Contact '81~"ft!b Geii~ Business phone: 24-Hour Phone Pager Phone / Title / DIRECTOR (661) 635-3050x168 (661) 428-2661x () x -1- React Phone: (661) 835-3050x state: CA Zip 93304 Phone: (661) 635-3050x State: CA Zip 93302 TotalASTs: = TotalUSTs: = RSs: No Gal Gal Vou(,- MOO~~ ENT'D APR 27 2007 :3 e.~ ftff~C-lJil) L-e:rr~ 01/29/2007 . i f'b 1 f,;-. .3 F CLINICA SIERRA VISTA f= Hazmat Inventory f== MCP+DailyMax Order SiteID: 015-021-002423 9 By Facility unit 9 Fixed Container$ at Site 9 Hazmat Common Name... SpecHaz EPA Hazards DailyMax MCP WASTE FIXER R L 5.00 FT3 Min -2- 01/29/2007 t1 1 i;- ~i' -3- 01/29/2007 1;; .. 1\ ;~, ' F CLINICA SIERRA VISTA p= Inventory Item 0001 = COMMON NAME / CHEMICAL NAME WASTE FIXER SiteID: 015-021-002423 9 Facility Unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit DARKROOM Map: Grid: CAS # STATE - TYPE Liquid Waste PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 5.00 FT3 AMOUNTS AT THIS LOCATION Daily Maximum 5.00 FT3 Daily Average 5.00 FTj %Wt. I Silver HAZARDOUS COMPONENTS ~ CAS # 7440~~241 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# Me:\? No No No No/ Curies R / / / Mifi HAZARD ASSESSMENTS -4- 01/29/2007 ;, . ,& ."; 1. SiteID: 015-021-002423 9 Fast Format "I Overall site 9 F CLINICA SIERRA VISTA I f= Notif./Evacuation/Medical Agency Notification x - (Lid r ~tL Employee Notif./Evacuation ~f(!)e; u.- N~, PI C-hi( Public Notif./Evacuation .N)~ Emergency Medical Plan 7fWVv fS1\ PC9)vrA- -5- 01/29/2007 " L" ^ ?f ~ SiteID: 015-021-002423 9 Fast Format 9 Overall Site 9 F CLINlCA SIERRA VISTA I p= Mitigation/Prevent/Abatemt Release Prevention ~r C,ffr/(h k~ V; Release Containment IlvF G-C/..- (~ f ,.I VI Clean Up ...fAN/If,,,,.. r&'d'~' ~"~~t I~".F-J /frL-L- ~,'1ijL f.-c>V'w'/~ Ie::( IV {).(.AJ CrJ w fJ U l..P fJf/ Nor} ~ €J!J ~i$f~ Other Resource Activation -6- 01/29/2007 , (~ f:!., 1. " SiteID: 015-021-0024~3 9 Fast Format '9 Overall Si Ee '9 f CLINICA SIERRA VISTA I p= Site Emergency Factors Special Hazards Utility Shut-Offs Fire Protec./Avail. Water 7f(Hrv~ P'f ~ I~ Y p F-Ib- Building Occupancy Level !i ~4>>'/AP) to -7- 01/29/:2007 i\ l'-~ 1> 1'1 i, F CLINICA SIERRA VISTA I F7 Training Employee Training SiteID: 015-021-002423 9 Fast Format 9 Overall Site "I f~ Page 2 Held for Future Use Held for Future Use -8- 01/29/2007 '" ......- ...... 1lWl.O.00b.X1Qft....00In. n. -..... . r100111CJ10" ..~ ~) '" 10' """"'" to'O".I'H" "" PalIInt'NlaB1tlRorm: tttt.. 1.0000.X 22ft....0llin. t-4oo WI e,lfi-- )U If.e...- 14- 10' -,- 13t1.e.00In.X10l1i.1.0lIn. '.7 """..... !ft. 1.oDIn. X 1ft. 1D.oDIn. 'oa ... 1IIl.10.0lIIn.X1an.2.Dt. 10. 'oa ""'.- ........ 61.8.oD1ft.Xtoa.2.0llIn. -.... f3ft..~.X10ll.',0lIln. '(l) ,A~ ... ~ 4I'O"...r '" 0._ m ,,. '" ........ ....... ,,,,,, ........ ...... lt8"x.... 1'3".8'3" 8'2"1l1'0" 10'2".8'10" .21 ........ 1.21 -- '23 .........""'" 10'0"1ltO'O" 8'D"IlB'3" 124 """'''' 3"0"11:1'0" ... ..... '4'0".20'(1' 50U1P 'B.4~~ Pl~ COMl1.lVl,UN ViY /.J€Ai1 U Cblfl1-- ". T_..... Z4'O'lIt3'r Pi 111 -- S'4.17S" x 8' 1.87S" r:: (,f,Cj2.I~v fAN~ ,.. we""", ,,. ,.. 127 n, ~ .....Room -""'" ...."'- to'r.10'0" 8'8".'0'0- 3'1"1l10'r 12'0".,0'0" 11'3"110'0" '" ....., .- 112 """"'" ''''O''x1l'8'' 8'3"111'0" o '" """"'" 35'0".7'0" '" '" .....- ..~- "1".'0'0" 10'0".'0'0" 113 .......... 10'0".10'0- t N ". .......... 10'0".10'0" 111 .....- 10'0"11:10'0" 133 """'" 3'8"11"11''' o vvPT~ 5/~ur or;.p ---,. .;. ... r Ope r a ii n g : Arvin Community Health Center ]46 N. Hill Arvin. CA 93203 Phone: (661) 854-3131 Fax: (661) 854-2689 California Avenue Community Health Center 601 California Avenue Bakersfield, CA 93304 Phone: (661) 323-6086 Fax: (661) 324-6301 Death Valley Health Center Hiway ] 27 P.O. Box 158 Shoshone. CA 92384 Phone: (760) 852-4383 Fax: (760) 852-4304 Delano Community Health Center 1508 Garces Hwy. Delano, CA 93215 Phone: (661) 725-4780 Fax: (661) 725-1048 East Bakersfield Community Health Center 815 Dr. MLK. Jr. Blvd. Bakersfield. CA 93307 Phone: (661) 322-3905 Fax: (661) 322-1370 Frazier Mountain Community Health Center 704 Lebec Road Lebec. CA 93243 Phone: (661) 248-5250 Fax: (661) 248-5279 Homeless Health Care Services 234 Baker Street Bakersfield. CA 93305 Phone: (661) 322-7580 Fax: (661) 322-7712 Kern River Health Center 67 Evans Road Wofford Heights, CA 93285 Phone: (760) 376-2276 Fax: (760) 376-4801 Kern Valley Medical Center 6310 Lake Isabella Blvd. Lake Isabella. CA 93240 Phone: (760) 379-24] 5 Fax: (760) 379-4060 Lamont Community Health Center (formerly Clinica Sierra Vista) 8787 Hall Road Lamont, CA 93241 Phone: (661) 845-3731 Fax: (661) 845-4511 McFarland Community Health Center 217 Kern Avenue McFarland. CA 93250 Phone: (661) 792-3038 Fax: (661) 792-6270 North of the River Community Health Center 2525 N. Chester Avenue Bakersfield. CA 93308 Phone: (661) 328-4295 Fax: (661) 399-0920 South Bakersfield Community Health Center 2400 Wible Road. #14 Bakersfield. CA 93304 Phone: (661) 835-1240 Fax: (661) 835-4667 34'" Street Community Health Center 3550 Q Street Bakersfield, CA 93301 Phone: (661) 324-1455 Fax: (661) 324-3720 ~ S\E~J? V -1L- ~ 00 Ul ~~~ C/~ Celebrating 30 Years of Caring for the Community 1430 Truxtun Avenue, 4th Floor, Bakersfield, CA 93301 Mailing Address: P.O. Box 1559, Bakersfield, CA 93302-1559 Business: (661) 635-3050 . Fax: (661) 869-1503 . www.clinicasierravista,org April 26, 2007 Jeanni Loven, Accounting Clerk Bakersfield Fire Department, Prevention Services 1600 Truxtun Ave, Suite 401 Bakersfield, CA 93301 Dear Ms. Loven: Let me thank you again for your assistance in navigating the required information you have been so patiently waiting for. Per our conversation, I offer the following amendments to our Business Plan for South Bakersfield Community Health Center, 2400 Wible, Suite 14 Bakersfield California. We offer 2 Emergency Contacts available 24/7 by cell phone: / 1) Clinica Sierra Vista, Administrator on call- This is a rotational position by the officers in our v administrative team. We carry a cell phone and will be able to provide information and access 24/7. The number is 661-428-5834. v' 2) Doug Moore, Facilities Manager - 24/7 phone number is 661-428-2661. V Emergency Medical Plan: If an employee became injured from chemical exposure, assuming this is not life threatening, we would transport the employee to our Workman's Compensation Care Provider, Central Valley Occupational Medical Group, 4100 Truxtun Ave., Suite 200, Bakersfield, California. 93309. 661-632-1540. rI Agency Notification- Product is handled by X-Ray solutions Office # 637-0404. tlRelease Prevention- Product is stored in an approved container. JClean up: Darkroom would be closed off and Agency would be notified. ~i1ity Shutoffs: Electric shut off is in a hallway panel shown on the drawing. Gas is on the meter bank on the northeast comer of the building. The water shutoff is outside on the southeast comer of the building. 'Ii Fire Protection/Available Water: Fire extinguishers are shown on the map, the closest hydrant is located on the far southeast comer of the property. The building is sprinklered. j Building Occupancy level: There are 20 employees on site. !:EmPloyee Training: Employees are subject to initial and periodic trainings administered by our Human Resources Department. OHSA, JCAHO, Title 22 compliance training is monitored by our Safety Officer. Training Records are stored in employee's personnel files in our Human Resources Office located at 1430 Truxtun Ave Suite 300, Bakersfield, Ca 93301. (661) 635-3050. Sincerely, Do~nager PROGRAMS INCLUDING: WIC (18 locations) . BEHAVIORAL HEALTH. PERINATAL CARE (CPSP) . CHDP . FAMILY PLANNING. BCCCP . BLACK INFANT HEALTH. CAL-LEARN/AFLP . TEEN SERVICES. HIV/AIDS SUPPORT SERVICES. NEIGHBORHOOD PARTNERSHIPS. MEDI-CAL/HEALTHY FAMILIES OUTREACH Providing medical, dental care, education and social services to the people of Kern and Inyo Counties since 1971. Joint Commission on Accreditation of Healthcare Organizatiol r~~-~~~~ 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: 661)852-2101 OCCUPANCY DISTRICT I BLOCK NO. DATE S:/z.4 I O~ TO TITLE FIRM OR DBA Gs:rnG<..c.A ~Kez.i,I COMPANY ADDRESS (CITY, STATE, ZIP) 2400 WI~l(,: fZ.() -:t.t ( \ ~USINESS PHONE ~OME PHONE CORRECT ALL REQUIREMENTS VIOLATIONS VlOl.ATION ,R",nw "" 1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.) COMBUSTIBLE WASTE / DRY VEGETATION 2 Provide non-combustible containers with tight fitting lids for the storage of combustible waste and rubbish pending its safe disposal. (U.F.C.) COMBUSTIBLE STORAGE 3 Relocate combustible storage to provide at least 3 feet clearance around motor fuse box/fire door (N.E.C.) (U.F.C.) 4 Relocate fire extinguisher(s) so that they will be in a conspicuous location, hanging on brackets with the top to the extinguisher not more than 5 feet above the floor. (N.F.P.A. No. 10) EXTINGUISHERS 5 Provide and install (amount) _____ approved (type & size) __________________ portable fire extinguisher to be immediately accessible for use in (area) _____________________________ (U.F.C.) 6 Re-charge all fire extinguishers. Fire extinguishers shall be services at least once each year, and/or after each use, by a person having a valid license or certificate. (U.F.C.) 7 Provide and maintain "EXIT" sign(s) with letters 5 or more inches in height over each required exit SIGNS (door/window) to fire escape. (U.F.C.) 8 Provide and maintain appropriate numbers on a contrasting background and visible from the street to indicate the correct address of the building. (B.M.C.) (U.F.C.) 9 Repair all (cracks/holes/openings) in plaster in (location) ______________________________________. FIRE DOORS / Plastering shall return the surface to its original fire resistive condition. (U.B.C.) FIRE SEPARATIONS 10 Rem ov e/ re p air (item & I oc at ion) _________________________________________________________' Self-closing doors shall be designed to close by gravity, or by the action of a mechanical device, or by an approved smoke and heat sensitive device. Self-closing doors shall have no attachments capable of preventing the operation of the closing device. (U.F.C.) 11 Remove all obstruction from hallways. Maintain all means of egress free of any storage. (U.F.C.) EXITS 12 Provide a contrasting colored and permanently installed electric light over or near required exit (location) ______________________________ to clearly indicate it as an exit. (U.F.C.) STORAGE 13 Remove all storage and/or other obstructions Irom fire escape landings and stairways stair shafts. (Fire escapes/stair shafts are to be maintained free from obstructions at all times.) (U.F.C.) 14 Extension cords shall not be used in lieu of permanent approved wiring. Install additional approved ELECTRICAL APPLIANCES electrical outlets where needed. (N.E.C.) (U.F.C.) 15 Remove multiple attachment cords from specific electrical convenience outlet (one plug per outlet) (N.E.C.) (U.F.C.) OUTDOOR BURNING 16 Violation of Section 1102 dealing with recreational fires or open burning. (U.F.C.) FIREWORKS 17 Violations of Section 7802 (U.F.C.) or 8.49.040 of the Bakersfield Municipal Code (B.M.C.) regarding fireworks. OTHER 18 PLCAse: S6'lV1c..e oR.. c.oNV&Z:r -ro WeT c.t-I0'1/(AL.. 140wD SYs1€M .j( ON (DATE) b ~4 oS: AN INSPECTION WILL BE MADE, IF NO COMPLIANCE HAS BEEN MADE, ADDITIONAL REGULATORY ACTION MAY BE INITIATED. o AN ENFORCEMENT ORDER WILL BE SENT BY CERTIFIED MAIL PROVIDING A HEARING DATE. AFTER VIOLATIONS ARE CORRECTED, RETURN THIS BY ORDER OF THE FIRE CHIEF DATE COMPLETED: NOTICE BY MAIL OR IN PERSON TO: W {~CS BAKERSFIELD FIRE DEPT. INSPECTOR SIGNATURE INSPECTOR SIGNATURE OFFICE OF PREVENTION SERVICES LEGEND: C.F.C. CALIFORNIA FIRE CODE 900 TRUXTUN AVE., SUITE 210 U.B.C. UNIFORM BUILDING CODE BAKERSFIELD, CA 93301 B.M.C. BAKERSFIELD MUNICIPAL CODE N.F.P.A. NATIONAL FIRE PROTECTION ASSOCIATION N.E.C. NATIONAL ELECTRIC CODE White - Customer/Original Yellow - Station Copy Pink - Prevention Services FD1916 (REV. 02/05) ~ 1(:<.1":~~~ >-,..:l,._~ P'~~_'~"_"__',.t- '...>~.",' --~..,"~' :";:; " \.:.~ , l' + ABC FAMILY DENTISTRY ================================ SiteID: 015-021-002911 + Manager : DAT TRAN DDS Location: 2400 WIBLE RD 12 City BAKERSFIELD BusPhone: Map : 123 Grid: lIB (661) 833-1533 CommHaz : Minimal FacUnits: 1 AOV: CommCode: BFD STA 07 SIC Code: EPA Numb: DunnBrad: +==============================================================================+ +=======================================+======================================+ Emergency Contact / TitleVA.1~ Emergency Contact / Title / / Business Phone: (&1Ij) 8 J~ -) 53)x Business Phone:) x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x Pager Phone" ceLl (robl '1('7 z - 1151 x Pager Phone : ( ) - X +--------------------------~------------+----------------~---------------------+ -1-c.Hazmat'-H:a'za:rds<:~.:.-.-.---~""_._. - ...-~.:. . - . - . Re'~ct " 0, ~ '-, - ~ .-"," " +--------~---------------------------------------------------------------------+ Contact: DAT TRANDDS Phone: (661) 833-1533x MailAddr: 2400 WIBLE RD 12 State: CA City : BAKERSFIELD Zip : 93304 +------------------------------------------------------------------------------+ Owner DAT TRAN DDS Phone: (661) 833-1533x Address : 2400 WIBLE RD 12 State: CA City : BAKERSFIELD Zip : 93304 +------------------------------------------------------------------------------+ Period to TotalASTs: = Gal Preparer: Total USTs : . . Gal Certif'd: RSs:'No ParcelNo: +------~-----~-----~-------------------------------_:--------------------------+ Emergency Direc.ti ves: III 1]v\ te:> PROG H - HAZ WASTE GEN (f'ZJ -1 Based on my inquiry of th . responsible for obtaining the infgr~atl.~di~idU~IS under penalty of law that I h I n, certify exam~ned and am familiar with ~~: prrson~l/y submltte and believe the . f .In o~matlon aCCurat and complete. In ormatIon IS true, ~~~\ ENT'D JUL 202006 --.-- ---:--...~",--z,- _o~ --._~__,______. ~">-_. -_.-.___ _ _ _,._ Date ~ 1!tJ1O +==============================================================================+ -1- 06/07/2006 ~~gL~ UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program :ACILlTY ~:~_~___~~___~'-I::~____Q~~.'s~~__ .__.___.,__ ADDRESS ""z&~_.__~~l)l-~____e:{t_____~~~__._..___________ __ FACILITY CONTACT ~l\ Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 INSPEJTION DJTE INSPECTION TIME _~_I__>6I~____ ~___~_________ PHONE No, No, of Employees ~------------ .--- Business ID Number Section 1: Business Plan and Inventory Program 15-021- LI Routine " $..l<,ombined LI Joint Agency LI Multi-Agency COMMENTS V\1\A: <; \l:S F I "'-C ~ .___________n___.u~~om__..______.________ ---- ._,___..__u______ ____on____ -"--.-..----- -' r'- om___...._____..u,_ ..u________..__ I:] I:] VERIFICATION OF QUANTITIES S- 6-At- _______ _____._____._ ________._____ ____._. __..._._ _.____ ..._.u____"._____.._..__._..______.._. _______.._n._ ____ ..._______n_.._.._ _ ________..... _._._. _ ___________.______~_ ____~~_t;.I_~~_ _._!':!.~_ c..t4Jl!-:.~._ B.~~_u I:] ._~.__~~~IFICATIO~_~~~~~_~~~IL~_~I=I~E___u____.._______---.t.u.~ ...__ _u____... I:] I:] VERIFICATION OF HAT MAT TRAINING . .___u__m___________~._,________________.~_________.u______.,_..,...___~.uo-----....uo. ...._,___..__._...,. _.___._ __n__.... '.. . _~___~_n~_=~~.I:~~I~N___~F A~~~_~~~:UPPLI:_~~.~~~_~O~:~~~=~ .t-uu- I:] I:] EMERGENCY PROCEDURES ADEQUATE I (] --Ci---C;~~~I~~~-P~~~~~~~--~~~~~~----- .___om____UO___n______._._.._ . t-.---m-- -., ----- _n___ .. u -- __m.____ --..-. - I:] ~O--H-~~~~~EPI~---------~- m___ ----- ..------------------t--. "1.,' __.____m._.______..____________.______..___..________..__ --------------- ,..-- ---r...------. ..'i," . ,~ -~- :11:~-~~2~~~E~~~T~-&--O~-HAN~.------------.II.-J:< ~ let' I I ! I C V ( C=Compliance ) V=Violation OPERATION I:] I:] ApPROPRIATE PERMIT ON HAND ,I:] I:] BUSINESS PLAN CONTACT INFORMATION ACCURATE (] I:] VISIBLE ADDRESS I:] I:] CORRECT OCCUPANCY I:] 1:]' VERIFICATION OF INVENTORY MATERIALS I:] I:] VERIFICATION OF LOCATION I:] n PROPER SEGREGATION OF MATERIAL ANY HAZARDOUS WASTE ON SITE?: j5tYES ~rB Y ,~Jl.., I:] No EXPLAIN: (] Complaint I:] Re-inspection . ..--------u-?;t\\.J.-~ //'-:) ..-, .~,\L--.,....,----...-----..- _m_.______ _ u' ____ . __ __ -q;m_ __ ---- . ~rr u __.~ _ _ ___ u_ __~ --rpO-Q. Most Insurances and Medi-Cal Accepted ABC FAMILY DENTISTRY 2400 Wible Rd., Suite 12 Bakersfield, CA 93304 Telephone: (661) 833-1533 / OAT THAN, D.D.S. QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 W I~...-s Inspector (Please Print) Fire Prevention 1st-In/Shift of Site While.. Environmenlai Services Yellow - Station Copy Pink - Business Copy a> i! N J2 --_.~~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME Me Vt><kl LY f) G.v\' s [flJ/ INSPECTION DATE U/'3o/()4 Section 4: Hazardous Waste Generator Program EPAID# ")Tlt.<.. AC(.vN1vLATING,- o Routine Ji- Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERATION C V COMMENTS Hazardous waste detennination has been made EP A ID Number Authorized for waste treatment and/or storage Reported release, fire, or explosion within IS 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 kep"t closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondary containment provided "(7LEl)..<;€, '?RVVII)€" '?LAo5IiC,. ~(,J 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 Detennines if waste is restricted from land disposal Inspector: Office of Environmental Services (661) 326-3979 White - Env. Svcs. C=Comphance V=Vlolatlon vJ f tV~t; Ie Party Pink - Business Copy 04 A---., ~ HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION CITY OF 13,-\KERSFlELD OFFICE OF ENVIRO:\f\-IENT.-\L SERVICES 1715 Chester Ave.. CA 93301 (661) 326-3979 i~~~_._.___ 0 A_OO ____.c?__OE~E!5. o REVISE ~oo " (one fa"" pe, matena' pe' bullding~' area, Page of I. FACILITY INFORMATION !iUS/NESS-NAME (Sameas FACILITY NAME 0.. DEjA. Doing BUSIness As) /).'6 C ~ I LY' 'DC'""-'TI5>1Y2Y '_._------_._------~ CHEMICAL LOCATION ---FACILity-.ID II : /N<;,{":lC ][----=J - N{;; c{4JR. ~ tACK oJ:F.cc I' MAp Ii (opt,onat;. . 203 201 CHEt~ICAL LOCATION CONFIOENTIAL (EPCRA) GRID /I (optional) o Yes 0 No 202 ---- --- -------264-- II, CiiEMICAL 1,IlFORMA TICN 2OS' . TRADE SECRET I CHEMICAL NAME i o Yes 0 No 2e6 ~'SIE: F.x~ If Subject (0 EPCRA. refer 10 InstructIons 1------ COMMON NAME 207 EHS' o Yes 0 No 208 CASII 209 .IC EHS is'Yes,' aU amounts below lIlIISI be ill Ibs. FIRE COOE HAZAROCLASSES (CoiTi-Piilte'i; requested' by 1000lfileCnie~ 210 ~, -...-..-----.-,... ---- -- I TYPE 0 P PURE 0 m MIXTURE 1-----.--.'----- -- , PHYSICAL STATE 0 s SOLIO !2h-t.IQUID .~ ;A5~S R-,UIOAc:TIVc 0 Yes 0 No --- --.. --~---CURIES 213 o 9 GAS 214 LARGEST CONTAINER ~T 2~5 FED HAZARO CATEGORIES (Chad( alllhal apply) ANNUAL WASTE AMOUNT 0, FIRE o 2 REACTIVE 03 PRESSjRE F:ELEASE dt:....4 A ;U-E HEALTH o 5 CHRONIC HEALTH 216 217 :"~IMt;M DAILY AMOUNT --_..~..-- ... . ..- .---.----..--.-.--.... UNITS' ~ ga GAL 0 d CU FT . If EHS. amounl must be in Ibs. ..5- ~ 18 .oVERAGE DAILY AMOUNT s- 219 STATE WASTE CODE 220 o Ib LBS LJ tn TONS 221 DAYS ON SITE 222 STORAGE CONTAINER (Check alt that apply) o a ABOVEGROUND TANK Db UNOERGROUNO TANK DC TANK INSIDE BUILOING o d STEEL DRUM De PLASTIClNONMETALLlC DRUM Of CAN o 9 CARBOY C h SILO o i FIBER DRUM [;1 BAG o k BOX o I CYLINDER o m GLASS BOTTLE ~ PLASTIC BOTTLE o 0 TOTE BIN o p TANK WAGON o q RAIL CAR o r OTHER 223 ;- STORAGE PRESSURE $.a AMBIENT o aa ABOVE AMBIENT o oa tlELOW AMBIENT 224 STORAGE TEMPERATURE 2[aAMBIENT 0 aa ABOVE AMBIENT %wr HAZARDOUS COMPONENT o b3 BELOW AMBIENT 0 c CRYOGENIC __L_p_ _ E~~_____ CAS # 225 226 227 DYes 0 No 228 229 2 230 231 DYes 0 No 232 233 3 234 235 DYes 0 No 236 237 4 " 238 i- 239 ! 0 Yes 0 No P240 .. i - , . . .- .--- -".-- 243 ; 0 Yes 0 No 244 _241 . i 5-~-'-------~:l__--=.'__ __.___ 245 III, SIGNATURE -PFlINT"NAME'a;-rITCE OF AUTHORize-OCOMPANYREPRESENTATIVC-" ,. P-.- SIGNATURE ~ t0c>~~ --.----- DATe--246"" .--.....---.... . 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