HomeMy WebLinkAboutHAZMAT INSP 6/1/2017BAKERSFIELD FIRE DEPT.
Prevention Services
13 ...F R 8 F 1. L-D
UNIFIED PROGRAM INSPECTION CHECKLIST 2101 H Street
FIRE
R rN r
. . ...... .... .. .... ARTM T Bakersfield, CA 93301
M.
Haz-Mat Business Plan and Inventory Program Tel.: (661) 326-3979
Fax: (661) 852-2171
FACILITY NAME Z
",
INSPECTION DATE
- / ...' . ..... .
INSPECTION TIME
A-10
ADDRESS
-Z
A
PHO!JE N.O.
j
O OF EMPLOYEES
FACILITY CONTACT ,,,
�4.
I /
COMMENTS
BUSINESS ID NUMBER
Conser to Inspect Name /Title
(CFC: 505.1, B
AC: 15.52.020)
M/ ❑ APPROPRIATE PERMIT ON HAND
V
ROUTINE ❑ COMBINED ❑ JOINT AGENCY El MULTI-AGENCY ❑ COMPLAINT El RE-INSPECTION
Date
White —Business Copy Yellow — Business Copy to be Sent n after return to Compliance Pink Prevention Services Copy FD2155 (Rev 1/14)
C v C=Compliance) OPERATION
V=Violation
COMMENTS
bl/ ❑ VISIBLE ADDRESS
(CFC: 505.1, B
AC: 15.52.020)
M/ ❑ APPROPRIATE PERMIT ON HAND
(E
MC: 15.65.080)
ID/ ❑ CERS UPDATED FOR THE CURRENT CAI
LLNUAK YEAR
(H&S 25404(e)
[9/ ❑ BUSINESS PLAN CONTACT INFORMATIO
IN ACCURATE
(CCR: 2729.1)
Cl/ ❑ VERIFICATION OF INVENTORY MATERIAdS
(CCR: 2729.3)
❑ VERIFICATION OF QUANTITIES
(CCR: 2729.4)
M/ ❑ VERIFICATION OF LOCATION
(CCR: 2729.2)
dY" 0 PROPER SEGREGATION OF MATERIAL
(CFC: 5004.1)
M/ ❑ SAFETY DATA SHEET AVAILABILITY
(CC
R:2729.2(3)(b))
[9-' ❑ VERIFICATION OF HAZ MAT TRAINING
(CCR: 2732)
0,*" ❑ VERIFICATION OF ABATEMENT SUPPLIES
AND PROCEDURES
(CCR:2731 (c))
[5� El EMERGENCY PROCEDURES ADEQUATE
(CCR: 2731)
CONTAINERS PROPERLY LABELED
(CCR: 66262.34 (f);
CFC* 5003.5)
❑ HOUSEKEEPING
(CFC: 304.1)
Egl ❑ FIRE PROTECTION
( C
FC: 903 & 906)
❑ SITE DIAGRAM ADEQUATE & ON HAND
(C
CR: 2729.2 (3))
ANY HAZARDOUS WASTE ON SITE? ❑
�YES [EKNO
Explain:
Signature of Receipt:
POST INSPECTION JNSTRUCTIONS FOR RETURN-
• Correct the violation(s) noted above by
• Within 5 days of correcting all of the violations, sign a
Bakersfield Fire Dept., Prevention Services, 2101 H Street,
TO-COMPLIANCE:
I 6 return d retu a copy of thi
California 93301
Signature (that all violations have been corrected as noted)
page to:
Date
White —Business Copy Yellow — Business Copy to be Sent n after return to Compliance Pink Prevention Services Copy FD2155 (Rev 1/14)