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10800 ROSSLYNN LN
Prevention Services UNIFIED PROGRAM INSPECTION CHECKLISTS 900 Truxtun Ave., Suite 2 10 4 E R7S F I ....... ...... ,R T .1 1. PR_ SF, ... !F E JfARFJW r FIRE Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program ARM Ir Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME , ADDRESS C 45S I vt4 � FACILITY CONTAq INPE ION ;7-, i 7 TE 13 INS 14PECTION TIME 4,!5© P H 8N E NO 1/ - 40511- gVqq BUSINESS ID NUMBER _Qqz A� NO OF EMPLOYEES 6/v 157 5- g . . . . . . . . . . . . . . . . . . . . . . ..................... lug ❑ ROUTINE ❑ COMBINED ❑ JOINT AGENCY ❑ MULTI-AGENCY ❑ COMPLAINT ❑ RE-INSPECTION,: C V C=Compliance) OPERATION V=Violation COMMENTS ❑ ❑ APPROPRIATE PERMIT ON HAND ❑ Business PLAN CONTACT INFORMATION ACCURATE 1:1 VISIBLE ADDRESS 1:1 CORRECT OCCUPANCY ❑ ❑ VERIFICATION OF INVENTORY MATERIALS ❑ ❑ VERIFICATION OF QUANTITIES ❑ 1:1 VERIFICATION OF LOCATION ❑ ❑ PROPER SEGREGATION OF MATERIAL ❑ 1:1 VERIFICATION OF MSDS AVAILABILITY ❑ ❑ VERIFICATION OF HAZ MAT TRAINING ❑ ❑ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ❑ EMERGENCY PROCEDURES ADEQUATE 1:1 CONTAINERS PROPERLY LABELED 1:1 HOUSEKEEPING 1:1 FIRE PROTECTION D k*X ,i<< ❑ 1:1 SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: ❑ YES NO QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1st in / Shift of Site/Station # Business Site Responsible Pa y (Please Print) I White — Prevention Services Yellow - Station Copy Pink — Business Copy FD 2155 (Rev. 09/05