The URL can be used to link to this page

Home My WebLink AboutBUSINESS PLAN 7/20/2007 j [e \ II ~ CLINICAL SIERRA VISTA II 2400 WIBLE ROAD I ,- - ES 1/52'" tJ 'J I' 'I 1\ J II I I It i : ., ~:i:' CLINICA SIERRA VISTA SiteID: 015-021-002423 Manager PAM MILLER Location: 2400 WIBLE RD 14 City BAKERSFIELD BusPhone: Map : 123 Grid: lIB (661) 835-3050 CommHaz : Minimal FacUnits: 1 AOV: CommCode: BFD STA 07 EPA Numb: SIC Code: DunnBrad: Emergency Contact PAM MILLER Business Phone: 24-Hour Phone Pager Phone / Title / ADMINISTRATOR (661) 835-3050x () x (661) 428-5834x Emergency Contact DOUG MOORE Business Phone: 24-Hour Phone Pager Phone / Title / FACILITIES MGR (661) 635-3050x168 (661) 428-2661x () x Hazmat Hazards: React Owner Address City CLINICA SIERRA VISTA 1430 TRUXTUN AVE 400 BAKERS FILED Phone: (661) 835-3050x State: CA Zip 93304 Phone: (661) 635-3050x State: CA zip 93302 Contact : CAROLINA CRUZ MailAddr: 2400 WIBLE RD 14 City BAKERS FILED Period Preparer: Certif'd: ParcelNo: to TotalASTs: = TotalUSTs: = RSs: No Gal Gal Emergency Directives: PROG H - HAZ WASTE GEN ENTD AUG 14 2007 Bar,ed on my inquiry of those individua.ls re~ncnslble for obtaining the mformatlon, I certify u~~der penalty of law tl1at '. have person~lIY examined and am familiar with the !nfo~matlOn submitt , and bel'eve the information IS true, aceu''- :e, and com, lete. 1 / 'VJ /01 Date -1- 07/10/2007 F CLINICA SIERRA VISTA f= Hazmat Inventory p== MCP+DailyMax Order SiteID: 015-021-002423 By Facility Unit Fixed Containers at Site 9 1 9 DailyMax IUnitlMCP 5.00 FT3 Min Hazmat Common Name... IspeCHazlEPA Hazards I Frm I WASTE FIXER R L -2- 07/10/2007 -3- 07/10/2007 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 FT3 %wt. I Silver HAZARDOUS COMPONENTS ~ CAS#7440224I TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min HAZARD ASSESSMENTS -4- 07/10/2007 F CLINICA SIERRA VISTA I p= Notif./Evacuation/Medical Agency Notification SiteID: 015-021-002423 9 Fast Format 9 Overall Site 9 04/27/2007 X-RAY SOLUTIONS 637-0404 Employee Notif./Evacuation Public Notif./Evacuation Emergency Medical Plan 04/27/2007 TRANSPORT TO CENTRAL VALLEY OCCUPATIONAL MEDICAL GROUP, 4100 TRUXTUN AVE 200, 632-1540. -5- 07/10/2007 SiteID: 015-021-002423 9 Fast Format, Overall Site 9 04/27/2007 F CLINICA SIERRA VISTA I f= Mitigation/Prevent/Abatemt Release Prevention PRODUCT IS STORED IN AN APPROVED CONTAINER Release Containment Clean Up 04/27/2007 DARKROOM WOULD BE CLOSED OFF AND AGENCY WOULD BE NOTIFIED. Other Resource Activation -6- 07/10/2007 , . " ." '" SiteID: 015-021-002423 9 Fast Format 9 Overall Site =t F CLINICA SIERRA VISTA I f= Site Emergency Factors Special Hazards Utility Shut-Offs 04/27/2007 GAS: NE CRNR OF BLDG ELECTRICAL: HALLWAY PANEL WATER: SE CRNR OF BLDG OUTSIDE Fire Protec./Avail. Water 04/27/2007 SPRINKLER SYSTEM AND FIRE EXTINGUISHERS FIRE HYDRANT: SE CRNR OF SITE Building Occupancy Level 04/27/2007 20 EMPLOYEES -7- 07/10/2007 !; r ,-.. ): 1. ,~.t F CLINICA SIERRA VISTA I f= Training Employee Training SiteID: 015-021-002423 9 Fast Format 9 Overall Site 9 04/27/2007 BRIEF SUMMARY OF TRAINING PROGRAM: EMPLOYEES ARE SUBJECT TO INITIAL AND PERIODIC TRAINING ADMINISTERED BY OUR HUMAN RESOURCES DEPT. OSHA, JCAHO, TITLE 22 COMPLIANCE TRAINING IS MONITORED BY OUR SAFETY OFFICER. TRAINING RECORDS ARE STORED IN EMPLOYEES PERSONNEL FILES IN HUMAN RESOURCES OFFICE AT 1430 TRUXTUN AVE 300 635-3050. Page 2 Held for Future Use Held for Future Use -8- 07/10/2007 UNIFIED PROGRAM INSPECTION CHECKLIST i~$.~;:"'.~:';;!;1J;:~;Ik"Ct.-~);i';~0.,$r;M'~c;, ~,~;';--~~,t;'J~;,:",~,~ '";'-~'!t:K>I:':i',(,(-;~;.r,.,', '-:",,:tf::I.'~': "'-~~ ;.r:-:'C:,';'-'t';::'i~-"/~",,,,::' A?" ..: -~.;",t .';" :",">A~1'FV .( .~'" r,~...~ . "-"~. ,",C&' SECTION 1: Business Plan and Inventory Program ~\ . FACILITY NAME CL \ (VI GAS \ E: I1JtA V \ S \: Wl~~ RD C(LU -7; ADDRESS BAKERSFIELD FIRE DEPI' Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield. CA 93301 Tel.: (661)' 326-3979 Fax: (661) 872-2171 1AOo FACILITY CONTACT ~L...l HO NO. ~S- 3056 USINESS 10 NUMBER O..A ? 15-021- 0 z..~t-3 . k .5tJ\f,Q..~J\S44- Section 1: Business Plan and Inventory Program o COMBINED 0 JOINT AGENCY 0 MULTI-AGENCY 0 COMPLAINT ROUTINE C V (C=ComPlianCe) V=Violation OPERATION COMMENTS o ApPROPRIATE PERMIT ON HAND jd-0~ ORE-INSPECTION Business PLAN CONTACT INFORMATION ACCURATE o VISIBLE ADDRESS fNi'D OEe ' ~ o NO 0 CORRECT OCCUPANCY 0 VERIFICATION OF INVENTORY MATERIALS 0 VERIFICATION OF QUANTITIES 0 VERIFICATION OF LOCATION 0 PROPER SEGREGATION OF MATERIAL 0 VERIFICATION OF MSDS AVAILABILITY ~ 0 VERIFICATION OF HAZ MAT TRAINING ~ 0 VERIFICATION OF ABATEMENT SUPPLIES AND CEDURES 0 EMERGENCY PROCEDURES ADEQUATE 0 Co NT AINERS PROPERLY LABELED 0 HOUSEKEEPING 0 FIRE PROTECTION 0 SITE DIAGRAM ADEQUATE & ON HAND ANY HAZA~US W~TE ON SITE? EXPLAIN: ~ft- l"l~ .QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326.3979 ~) -It/10 . 1 ,.c, Inspector (Please Print) Fire Prevention /1&1 In / Shift of Site/Station # White - Prevention Services Yellow - Station Copy Pink - Business Copy \(fJ (Please Print) F02049 (Rev. 02105) 5~~11t Prevention Services. . D 900 Truxtun Ave., Suite 210 Bakersfield. CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 ~ "t"" t-~"\.. -~:'\. UNIFllo PROGRAM INSPECTION CHECKLIST SECTION 1: Business Plan and Inventory Program FACILITY NAME INSPECTION TIME ^11c::... c ,.... "" AM." L-( De ,...+, s-/e ADDRESS P- ~ -d: 'L 2i.fOO FACILITY CONTACT ,~,-e: ~ 'I o MULTI-AGENCY o COMPLAINT C V ( C ComPlianCe) OPERATION V=Violation 0 ApPROPRIATE PERMIT ON HAND 0 Business PLAN CONTACT INFORMATION ACCURATE 0 VISIBLE ADDRESS 0 CORRECT OCCUPANCY 0 VERIFICATION OF INVENTORY MATERIALS 0 VERIFICATION OF QUANTITIES 0 VERIFICATION OF LOCATION 0 PROPER SEGREGATION OF MATERIAL 0 VERIFICATION OF MSDS AVAILABILITY 0 VERIFICATION OF HAZ MAT TRAINING 0 VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES 0 EMERGENCY PROCEDURES ADEQUATE ~ 0 CONTAINERS PROPERLY LABELED ~ 0 HOUSEKEEPING D~ FIRE PROTECTION '6<7 ~ '\. \ -' l.. - -. 0 SITE DIAGRAM ADEQUATE & ON HAND COMMENTS s if... "('\0-'5 ~e. EXPLAIN: ANY HAZARDOUS WASTE ON SITE? ~ YES o Q.. rlL-tl)l.-~ r o NO QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 -- Vtf Ir'~ sible Party (Please Print) (/ ~a..)L,1 ......J Inspector (Please Print) Fire Prevention /1" In / Shift of Site/Station # -----. ~-"--.. White- Prevention Services Yellow - Station Copy Pink - Business'Copy FD 2155 (Rev. 09/05 . -~ . ---" \ ---- '\...- ~ ~'''' CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME t:\Q,C- ~+ f'^ I L)I lJ... "" ~ ~-ft , . INSPECTIONDATE if/ lflc) EP A ID # Z;'x. 'f, .", {>i' Section 4: Hazardous Waste Generator Program o Routine ~ 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 r; )<..~ .."'" f-\ Authorized for waste treatment and/or storage .... ...... ,...:lO 9"<- v \ (,A. ~.... ~l ~ c. It.. Reported release, fire, or explosion within 15 days of occurrence .~ ..J Established or maintains a contingency plan and training ............. - Hazardous waste accumulation time frames No J..,Abo\$ Containers in good condition and not leaking - ..s ---J , Containers are compatible with the hazardous waste Containers are kept closed when not in use -----oJ Weekly inspection of storage area -----~ Ignitable/reactive waste located at least 50 feet from property line ,.;/~ Secondary containment provided --- I- Conducts daily inspection of tanks --1-1 Used oil not contaminated with other hazardous waste tJ).,.. Proper management of lead acid batteries including labels JJ /Jo Proper management of used oil filters fII / ;. Transports hazardous waste with completed manifest '" " r'\~ I\. t f... s1; NO Sends manifest copies to DTSC 1-........ ......, tJO ~__~ r J.-.i. ~ eA.--"'o +dj)tSL ~ Retains manifests for 3 years '...... '-J f"^ Cl ,,\-f ~ ~ "'r .i NO Retains hazardous waste analysis for 3 years '-4 Retains copies of used oil receipts for 3 years tJ fA Detennines if waste is restricted from land disposal ....... i'o C-Compliance V-Violation k<.o """... _J.~J ~c:) ..!<:7i- iAI ~t.I"'v 'c.,- ....; ..... f ~ Go po. J ~--- Business Site Responsible Party Inspector: I""./C( &e-,,.... J Office of Environmental SeJVices (661) 326-3979 White - Env. Svcs. Pink - Business Copy UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 9330 1 Tel: (661)326-3979 ~~_ll.ITY_~A~JV\ ~~__Si~__~l~f"~______ - --- ---------- ------ -- - - ~--t- 'N;Qrri'~~~ ~~s_~r~~~:E__ ADDRESS Pi\"ONE No. 1- No of Employees ____2400 W ll~ ____~lt________ ___________ m_ __________ 2>~_~- )~ n L~- _ ____ _ FACILlTYC ACT Business 10 Number 15-021- OD~ 2.3 V f~' outine LI Combined LI Joint Agency LI Multi-Agency LI Complaint bEe 1 LI Rftinspection Section 1: Business Plan and Inventory Program COMMENTS t~~~~ LI CORRECT OCCUPANCY ~LI VERIFICATION OF INVENTORY MATERIALS ---------------~---_._---------,,-_._------_._----,....----.---- LI VERIFICATION OF QUANTITIES .__ u____._____.__~__________.._______________.._____._______."_"""__ ..__n. M LI VERIFICATION OF LOCATION -r.--.-.-------,----.-----~.--,---.----------.---------------~-..- LI PROPER SEGREGATION OF MATERIAL LI VERIFICATION OF MSDS AVAILABIUTYE LI VERIFICATION OF HAT MAT TRAINING . LI VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~_~___~~~~~NCY PROCEDURES ADEQUATE 1 /-~ - ----- - - -------- - _ __ - -""'I'l---- _____ _____ ~ _ _ __ _ __ __ __ __ _ ___ _ _ __ __ ____ _ _ .. _ u. __._.__. '__u.....__._. l:;- ~__~ONT~~E~S PRO~~_~~~ _~B:_~=~ ____ _ __ ____ ____ _ __ _~ ____ ______ ___ _ __ _____ _ _ _ __m_____._______ u______ . LI HOUSEKEEPING I --- --- _____..__~_.____~___________u_________.___._____n____... _.. ___.___.____ ___ _____.__._ ______n_..______..__._._.__.___.____._._._______. _ _ __ _____ ___..._ LI FIRE PROTECTION __u__._________________ _____..__n__...__"___._..___._____.________.__._.__ _.____ ___.__.__ _.._________._._ ___..._.._______.n._n___._____..___ ._:.._ ._u_._._ __. __...._..___.____ ._.'_ LI SITE DIAGRAM ADEQUATE & ON HAND I A><v HAZARDOUS WASTE ON SITE?: ~S EXPLAIN: WA)(t.-- f\J<tlIL- C CJ No QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 . .'\ ____ ^~_\ j :t '\ ~ _ _0._ _() 0 - tr-~ In5~------.----.-----~--BadfNO~,--------. (\-LC\r-a~~sil:Re~o~ White . Environmental Sel'llices Yellow . Slalion Copy Pink . Business Copy Bakersfield Fire Dept. UNIFIED PROGRAM INSPECTION CHECKLIST Enironmental Services. 1715 Chester Ave SECTION 1 Business Plan and Inventory Program Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME C' ! INSPECTION DATE I INSPECTION TIME AD~l~-~-~~ _H~.I__~_~~_k H_{\~_ !-~---------- -- - ___m_ ..___..H_____ - --H..---i..' :l:e-!$-~ 6 3-iNo/J~~ees--- _Z}1 () (L~~~__ ~Q______2~_LLJ______H_____'___'________ __________ ~~_~12l/Ql____L~_._______ FACllITYCONTACT . Business 10 Number El i LA-- LOMA-S' (5-021- 00 2.-'1 z.. ~ / rI Routine Section 1: Business Plan and Inventory Program o Combined o Joint Agency o Multi-Agency o Complaint ORe-inspection ( C=Compliance ) V=Violation OPERATION COMMENTS ~: do ApPROPRIATE PERMIT ON HAND . ------------ _._------_._-------------_._.~--_._._---------------~-.--- BUSINESS PLAN CONTACT INFORMATION ACCURATE ~~SIBLE -:ORESS ----------. --.----.----- _____________._____________._______.________.._._._H..__-.------- ----- 7 0 C-;;RRECT OCCUPANCY~=~=~=~~_-- _=~===~__;,.~~~-~~===-===-n-- o ~O VERIFICATION OF INVENTORY MATERIALS VERIFICATION OF QUANTITIES r7n-- VERIFICATION ~; LOCA~~N -------------~ ~= ~ i;;~--~;-~;, ;L (? -~~ ------.:~_~~~:~-~~~_~- ~~ :::::.::R:::::V:::,~~---------------- ------- ------ ----- ~ VERIFICATION OF HAT MAT TRAINING __________m._______ --------------"--------.----.----------------- o VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ...// - ------- ------,----.....------------"'---.------------,-- V1 0 EMERGENCY PROCEDURES ADEQUATE . --~-------- -.------------r..-------.:...--.'.-.-----------------------------,,----,.----.---,--'...--- r::( 0 CONTAINERS PROPERLY LABELEO -70 HOUSEKEEPING -------------.-~I ..---------.-----.-----------------..--....----.---------- ~~- F~E p~~_~~~~~______,__~~~~=_==~~_ _=--==-_-~~=~~~=~~-===~-~_~=_=~.~',~~~_=_~=_ ;10 SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?: ~S o No -,V EXPLAIN: r') . r I >Ie'" :5 /' /j c.- :>,/ /--= T;: , ., ~.;: ~ij (:J ~/ ,~; /,"lI1:.. /"7 I ~;.. ""'~.:~~ .~::~ l.:) 1.) / :~~~r~nON?_~~EC~~~~ AT (661) 326-3979 _ ~ _, 1A.liLLdlcV ,,,-, B.d" No_ ::f:I--~". Re,poo""" Pony '1 ~ White . Environmental Services Yellow - Stallon Copy Pink - BUSiness Copy t:- fj 51}~1 (p 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 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title DAT TRAN DDS / ow~ / Business Phone: (661) 833-1533x Business Phone: ( ) - x 24-Hour Phone : (bb\ ) 'f 3~- Iq SClx 24-Hour Phone : ( ) - x Pager Phone : (661) 932-1959x Pager Phone : ( ) - x Hazmat Hazards: - Contact : DAT TRAN DDS MailAddr: 2400 WIBLE RD 12 City : BAKERSFIELD Owner DAT TRAN DDS Address : 2400 WIBLE RD 12 City : BAKERSFIELD React - Phone: (661) 833-1533x State: CA Zip : 93304 Phone: ( 661) 833-1533x State: CA Zip : 93304 Period : Preparer: Certif'd: ParcelNo: to TotalASTs: = TotalUSTs: = RSs: No Gal Gal Emergency Directives: PROG H - HAZ WASTE GEN EN\'n ~ ~ ~ 4 t~07 ~\~ Lat.~(J .l:;rl my Inquiry of those individuals resp~nal!,'Jl@ for obtaining the Information, I certify unde~ P~Mlty of law that I have personally examl.Md and am familiar with the information submitted and b",II€lve the information is true accurate, and complete. ' ~ -- DJ/2Il1- -1- 01/24/2007 ;; F ABC FAMILY DENTISTRY p= Hazmat Inventory p== MCP+DailyMax Order SiteID: 015-021-002911 , By Facility unit 9 Fixed Containers at Site 9 Hazmat Common Name... SpecHaz EPA Hazards Dai1yMax MCP WASTE FIXER R L 0.25 GAL Min -2- 01/24/2007 ,- .. -3- 01/24/2007 , F ABC FAMILY DENTISTRY p= Inventory Item 0001 F= 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 Gr] CAS # I 7440224 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 01/24/2007 F ABC FAMILY DENTISTRY I p= Notif./Evacuation/Medical Agency Notification SiteID: 015-021-002911 9 Fast Format 9 Overall Site 9 Employee Notif./Evacuation Public Notif./Evacuation Emergency Medical Plan -5- 01/24/2007 '"! SiteID: 015-021-002911 1 . Fast Format 9 Overall Site 9 F ABC FAMILY DENTISTRY I f= Mitigation/Prevent/Abatemt Release Prevention Release Containment SJt - Cow-{a:.- ~+- Clean Up Other Resource Activation -6- 01/24/2007 _-"1, . . ..... SiteID: 015-021-002911 , Fast Format 9 Overall Site 1 F ABC FAMILY DENTISTRY I F Site Emergency Factors Special Hazards Utility Shut-Offs _ vJdn ~ ~~sr - _ ~l1 SE ~- tJE ~ ~s~~ Fire Protec./Avail. Water Sf'!.U-.(c6-.- -( S w ""'~ #;~-r . Building Occupancy Level f W~(. -7- 01/24/2007 '-U ''Ii J, :::!' F ABC FAMILY DENTISTRY I I f= Training === Employee Tralnlng J~ SiteID: 015-021-002911 9 Fast Format 9 Overall site 9 = Page 2 I Held for Future Use HeIdi for Future Use I I , I I -8- 01/24/2007