HomeMy WebLinkAboutBUISNESS PLAN 1/12/2009; Prevention Services
UNIFIED PROGRAM INSPECTION CHECKLIST i~ B A F R S F, D 9001Yuxtun Ave., suite 2~0
-- - _._ _-- -- - ---- _ - --- --- _ ~~
- -~- --,; FiaE _ Bakersfield, CA 93301
'` ° aR~M Tel.: (661) 326-3979
SECTION 1: Business Plan and Inventory Program ~; Fax: (661) 872-2171
FACILITY NAME
i~l
- INSPECTION DATE
-
~ INSPECTION TIME
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ADDRESS
Z~~ v~ v~ ~~- 'C_ ~ PHONE NO.
32Z . i S ~ 3 O OF EMPLOYEES
3 2
FACILITY CONTACT BUSINESS ID NUMBER
15-021- 0 o U ~~~
Section 1: Business Plan and Inventory Program
0.ROUTINE ^ COMBINED ^ JOINTAGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION
C V, ( C=Compliance~ OPERATION
V=Violation COMMENTS
^ APPROPRIATE PERMIT ON HAND
l!d' ^ BUSIf18SS 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
~G ^ EMERGENCY PROCEDURES ADEQUATE
~^ CONTAINERS PROPERLY LABELED
^ HOUSEKEEPING
^ FIRE PROTECTION
^ SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITE? ^ YES ^ NO
EXPLAIN
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979
r~; k`~w.5~~ ~ /~
Inspector (Please Print) Fire Preuention / 1" In / Shift of Site/Station #
White - Prevention Services Yellow - Station Copy Pink - Business Copy . FD 2155 (Rev. 09/05
+ KLEE~RZ ___________________________________________= SiteID: 015-021-000589 +
Manager : DON DOERKSEN BusPhone: (661) 325-3374
Location: 2219 BRUNDAGE LN Map : 102 CommHaz : Moderate
City : BAKERSFIELD Grid: 36D FacUnits: 1 AOV:
CommCode: BFD STA 06 SIC Code:1541
EPA Numb: DunnBrad:
+______________________________________________________________________________+
+_______________________________________+______________________________________+
Emergency Contact / Title Emergency Contact / Title
/ PRESIDENT / GENERAL MANAGER
Business Phone: (661) 664-0950x Business Phone: (661) 325-3374x
24-Hour Phone :(661) 203-9900x 24-Hour Phone :(661) 599-5800x
Pager Phone : ( ) - x Pager Phone : ( ) - x
+------------------------------------- --+--------------------------------------+
~ Hazmat Hazards: React ~
+------------------------------------- -----------------------------------------+
Contact : TIMOTHY DENARI Phone: (661) 664-0950x
MailAddr: PO BOX 81327 State: CA
City : BAKERSFIELD Zip : 93380-1327
+------------------------------------- -----------------------------------------+
Owner TIMOTHY DENARI Phone: (661) 664-0950x
Address : PO BOX 81327 State: CA
City : BAKERSFIELD Zip : 93380-1327
+------------------------------------- -----------------------------------------+
Period . to TotalASTs: = Gal
Preparer: TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
+------------------------------------- -----------------------------------------+
~ Emergency Directives: ~
PROG A - HAZMAT
PROG H- HAZ WASTE GEN
~
~~,.~ers 2-d• c 7
~- ~~ ~~P
Co ~ -~c L~S ~ ~~t'r'~
32 v - 70o O
2U3~- ~r~~
3Z~y- gy~s
+______________________________________________________________________________+
-1- os/a5/2ooa
+ KLEENERZ ____________________________________________ SiteID: 015-021-000589 +
+= Hazmat Inventory _________________________________________ By Facility Unit +
+_= MCP+DailyMax Order ______________________________ Fixed Containers on Site +
+--------------------------------+-------+-----------+-----+----------+----+---+
~ Hazmat Common Name... ~SpecHaz~EPA Hazards~ Frm I DailyMax ~Unit~MCP~
+--------------------------------+-------+-----------+-----+----------+----+---+
SYNTHETIC ALIPHATIC HYDROCARBON
WASTE SYNTHETIC ALIPHATIC HYDRO
R L 150.00 GAL Low
R L 25.00 GAL Low
+______________________________________________________________________________+
-2- 08/25/2008
+ KLEENERZ ____________________________________________ SiteID: 015-021-000589 +
+= Inventory Item 0001 _______________ Facility Unit: Fixed Containers on Site +
+_= COMMON NAME / CHEMICAL NAME ______________________________+________________+
SYNTHETIC ALIPHATIC HYDROCARBON I Days On Site I
DF 2000 DRY CLEANING FLUID 365
Location within this Facility Unit Map: Grid: +----------------+
W WALL CENTER OF BLDG ~ CAS# I
+_____________________________________________________________+________________+
+= STATE _+= TYPE ___+_= PRESSURE ___+ TEMPERATURE __+___= CONTAINER TYPE _____+
~ Liquid I Mixture ~ Ambient I Ambient ~ IN MACHINE/EQUIP ~
+_________+__________+_______________+_______________+_________________________+
+__________________________+ AMOUNTS AT THIS LOCATION =________________________+
I Largest Container I Daily Maximum I Daily Average ~ I
150.00 GAL 150.00 GAL 150.00 GAL
+__________________________+_________________________+_________________________+
+_______+______________ HAZARDOUS COMPONENTS =_____________+___+_______________+
I 100t00IPerchloroethylene INosl CAS# 127184I
+_______+--------------------------------------------------+---+-----_---------+
------------------------------- --- ---- ---------
+_______+___+______+__________= HAZARD ASSESSMENTS =__+_________+________+_____+
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No I No/ Curies I R I/// I I Low I
+_______+___+______+____________________+_____________+_________+________+_____+
+__________________________ MISC. LOCAL AGENCY DATA =__________________________+
I Ag.Definedl: Ag.Defined2: Ag.Defined3: Ag.Defined4: • ~
Ag.Defined5: Ag.Defined6: Ag.Defined7:
Ag.Defined8: Ag.Defined9: Ag.Definel0:
+- Ag.Definell ----------------------------------------------------------------+
+______________________________________________________________________________+
-3- 08/25/2008
+ KLEENERZ ____________________________________________ SiteID: 015-021-000589 +
+= Inventory Item 0002 _______________ Facility Unit: Fixed Containers on Site +
+_= CONIMON NAME / CHEMICAL NAME ______________________________+________________+
WASTE SYNTHETIC ALIPHATIC HYDROCARBON Days On Site
365 I
Location within this Facility Unit Map: Grid: +----------------+
INSIDE SW CRNR OF STORE I CAS# I
127-18-4
+_____________________________________________________________+________________+
+= STATE _+= TYPE ___+_= PRESSURE ___+ TEMPERATURE __+___= CONTAINER TYPE _____+
~ Liquid ~ Waste ~ Ambient ~ Ambient ~ OTHER - SPECIFY ~
+_________+__________+_______________+_______________+_________________________+
+__________________________+ AMOUNTS AT THIS LOCATION =________________________+
I Largest Container I Daily Maximum I Daily Average I
15.00 GAL 25.00 GAL 15.00 GAL
+__________________________+_________________________+_________________________+
+_______+______________ HAZARDOUS COMPONENTS =_____________+___+_______________+
I 100t00IPerchloroethylene INosl CAS# 127184I
+_____-_+__________________________________________________
- -------- +___+_______________+
+_______+___+______+__________= HAZARD ASSESSMENTS =__+_________+________+_____+
ITSecretl RSIBioHazl Radioactive/Amount I EPA Hazards I NFPA I USDOT# I MCP I
No No No No/ Curies R /// Low
+_______+___+______+____________________+_____________+_________+________+_____+
+__________________________ MISC. LOCAL AGENCY DATA =__________________________+
~ Ag.Definedl: Ag.Defined2: Ag.Defined3: Ag.Defined4: ~
Ag.Defined5:
Ag.Defined6:
Ag.Defined7:
Ag.Defined8:
Ag.Defined9:
Ag.Definel0:
+- Ag.Definell ----------------------------------------------------------------+
+______________________________________________________________________________+
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+ KLEENERZ ____________________________________________ SiteID: 015-021-000589 +
+= Inventory Item 0002 _______________ Facility Unit: Fixed Containers on Site +
+__________________+_________+_____= WASTE DATA =__________+___________________+
I Treated On Site I CA Code I US Code I GAL Generated/Mo.l GAL Generated/Yr.l
No
+------------------+---------++--------+-------------------+-------------------+
~ Treatment UnitID: ~ Unit Type: I
+-----------------------------+------------------------------------------------+
~ Agency-Defined Text Label ~
+______________________________________________________________________________+
-5- 08/25/2008
+ KLEENERZ ____________________________________________ SiteID: 015-021-000589 +
+_________________________________________________________________ Fast Format +
+= Notif./Evacuation/Medical ____________________________________ Overall Site +
+_= Agency Notification ___________________________________________ 03/Ol/2005 +
MACHINERY THAT CONTAINS SOLVENT IS CHECKED DAILY FOR LEAKS.
+______________________________________________________________________________+
+__= Employee Notif./Evacuation ___________________________________ 07/05/2006 +
CALL 911 AND 326-3979 FOR MINOR SPILLS. CALL 911 AND 800-852-7550 FOR MAJOR
SPILLS.
+______________________________________________________________________________+
+___= Public Notif./Evacuation ____________________________________ 07/05/2006 +
TR.AINED MANAGER WILL EVACUATE AREA AND CLEAN UP SPILL WITH ABSORBENT
MATERIAL. MANAGER WILL CALL PROPER AUTHORITIES IF MAJOR SPILL. IMMEDIATELY
EVACUATE THE CUSTOMER AREA BEFORE STARTING THE CLEAN-UP PROCEDURE.
+______________________________________________________________________________+
+____= Emergency Medical Plan _____________________________________ 07/05/2006 +
IF SOMEONE IS OVER-EXPOSED, THEY WILL BE TAKEN TO LOCAL HOSPITAL.
+______________________________________________________________________________+
-6- 08/25/2008
+ KLEENERZ ____________________________________________ SiteID: 015-021-000589 +
+_________________________________________________________________ Fast Format +
+= Mitigation/Prevent/Abatemt ___________________________________ Overall Site +
+_= Release Prevention ____________________________________________ 03/O1/2005 +
ALL SOLBENT IS KEPT IN SEALED CONTAINER OR IN EQUIPMENT. ALL EQUIPMENT HAS
BASE PAN THAT WILL COLLECT ANY SPILL. MACHINE IS VISUALLY CHECKED DAILY.
+______________________________________________________________________________+
+__= Release Containment __________________________________________ 03/O1/2005 +
MACHINERY IS INSPECTED DAILY. EMPLOYEE IS TR.AINED TO NOTICE ANYTHING
+______________________________________________________________________________+
+___= Clean Up ____________________________________________________ 07/05/2006 +
ANY SOLVENT RELEASED WILL BE ABSORBED IN ABSORBENT MATERIAL AND PUT BACK
INTO MACHINE.
+______________________________________________________________________________+
+____= Other Resource Activation ______________________________________________+
+______________________________________________________________________________+
-7- 08/25/2008
+ KLEENERZ ____________________________________________ SiteID: 015-021-000589 +
+_________________________________________________________________ Fast Format +
+= Site Emergency Factors ______________________________________= Overall Site +
+_= Special Hazards ___________________________________________________________+
+______________________________________________________________________________+
+__= Utility Shut-Offs ____________________________________________ 05/29/2007 +
GAS - S WALL E CRNR OF BLDG
ELECTRICAL - S WALL OF BLDG
WATER - S OF BLDG IN GROUND
+______________________________________________________________________________+
+___= Fire Protec./Avail. Water ___________________________________ 07/05/2006 +
FIRE HYDRANT - NE CRNR BRUNDAGE LN & HUGHES AND NW CRNR HUGHES & HWY 58
OVERPASS.
+______________________________________________________________________________+
+____= Building Occupancy Level ___________________________________ 12/11/2006 +
11 EMPLOYEES
+______________________________________________________________________________+
-$- 08/25/2008
+ KLEENERZ ____________________________________________ SiteID: 015-021-000589 +
+_________________________________________________________________ Fast Format +
+= Training _____________________________________________________ Overall Site +
+_= Employee Training _____________________________________________ 07/05/2006 ±
MATERIAL SAFETY DATA SHEETS ON FILE IN A CHITE CABINET IN BACK OF BLDG.
BRIEF SUNIMARY OF TRAINING PROGRAM: KEY EMPLOYEES ARE TRAINED TO BE AWARE OF
ANY CHANGE IN MACHINERY OPERATION. TO VISUALLY CHECK MACHINE DAILY. THEY
ARE TRAINED ON HOW TO CLEAN UP SPILL.
+______________________________________________________________________________+
+__= Page 2 ___________________________________________________________________+
+______________________________________________________________________________+
+___= Held for Future Use _____________________________________________________+
+------------------------------------------------------------------------------+
--------- --------------------------------------------- --------------
+____= Held for Future Use ____________________________________________________+
+______________________________________________________________________________+
-9- 08/25/2008
+ KLEENERZ ____________________________________________ SiteID: 015-021-000589 +
+_________________________________________________________________ Fast Format +
+= Response/Risk Management _____________________________________ Overall Site +
+_= Operations ________________________________________________________________+
+______________________________________________________________________________+
+__= Planning _____________________________________________ +
+______________________________________________________________________________+
+___= Logistics _______________________________________________________________+
+______________________________________________________________________________+
+____= Finance/Administration _________________________________________________+
+______________________________________________________________________________+
-10- 08/25/2008