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UNIFIED PROGRAM INSPECTION CHECKLIST
SECTION 1: Business Man and Inventory Program
FACILITY NAME ^
X / — /
Prevention Servicesjg S f 1 R D 900 Truxtun Ave., Suite 210
RE Bakersfield, CA 93301
TN Tel.: (661) 326 -3979
Fax: (661) 872 -2171
FACILITY NAME ^
X / — /
INSPECTION DATE
co — —Z
INSPECTION TIME
07:"o
ADDRESS PHONE NO. NO OF EMPLOYEES
f
FACILITY CONTACT BUSINESS ID NUMBER
15 -021-
Section 1: Business Plan and Inventory Program
OUTINE COMBINED JOINT AGENCY MULTI - AGENCY COMPLAINT RE- INSPECTION
C V Q C= Compliance OPERATION
V= Violation
COMMENTS
APPROPRIATE PERMIT ON HAND
Business PLAN CONTACT INFORMATION ACCURATE
VISIBLE ADDRESS
Pf-- 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
HOUSEKEEPING
FIRE PROTECTION
SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITE? gaYES NO / %-
EXPLAIN: Cam'` / " -' ` r
QUESTI NS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326 -3979
v 11
Inspector (Please Print) Fire Prevention / 1" In / Shift of Site /Station # Business Site / Responsible Party (Please Print)
White – Prevention Services Yellow - Station Copy Pink – Business Copy FD 2155 (Rev. 09/05