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UNIFIED PROGRAM INSPECTION CHECKLIST
SECTION 1: Hazardous Materials Business Plan
Inspection
FACILITY NAME
1�
INSPECT/ION� ATE
(10 /CQlr,—
INSPECTION TIME
ADDRESS
�
C '3 c r � PZ
�.�
PHONE NO.
NO OF EMPLOYEES
FACILITY CONTACT
BUSINESS ID NUMBER
Consent to Inspect Name/Title
CERS INFONMATION
C V G=Gompflanco
V= Violation; l j
Section 1: Business Plan and. lnventory. Rrograrn
ROUTINE
El COMBINED ❑ JOINT AGENCY ❑ MULTI - AGENCY ❑ COMPLAINT ❑ RE- INSPECTION
C V G=Gompflanco
V= Violation; l j
OPERATION
CERS
Violation
COMMENT
APPROPRIATE
PERMIT ON HAND (BMC: 15.65.080)
3010001
f+
CERS INFONMATION
ENTERED & UPDATED ANNUALLY (CCR: 2729.1)
3210043
VISIBLE ADDRESS
(CFO: 505.1, BMC: 15.52.020)
CORRECTOCCUPANCY
(CBC:401)
VERIFICATIN OF INVENTORY MATERIALS (CCR: 2729.3)
1010004
7
VERIFICATION OF QUANTITIES (CCR: 2729.4)
1010006
VERIFICATION OF LOCATION (CCR: 2729.2)
PROPER SEGREGATION OF MATERIAL (CFC: 2704.1)
T
VERIFICATION
OF SDS AVAILABILITY (CCR: 2729.2(3)(b))
VERIFICATION
OF HAZ MAT TRAINING (CCR: 2732)
1020002
VERIFICATION
OF ABATEMENT SUPPLIES & PROCEDURES (CCR: 2731(c))
EMERGENCY
PROCEDURES ADEQUATE (CCR: 2731)
1010010
CONTAINER
PROPERLY LABELED (CCR: 66262.34(f , CFC: 2703.5)
3030007
HOUSEKEEPING
(CFC: 304.1)
FIRE PROTECTION
(CFC: 903 & 906)
3030032
-�
SITE DIAGRAM
ADEQUATE & ON HAND (CCR: 2729.2)
1010005
ANY HAZARDOUS WASTE
ON SITE? ❑ YES ❑ NO
Signature ofRecei t
Explain:
Inspector:
POST INSPECTION INST]
• Correct the violation(s)
• Within 5 days of correc
Bakersfield Fire Dent
White -
Dted above by
ig all of the violations, sign and return a copy of this page to:
Prevention Services, 2101 H Street, California 93301
Copy Yellow - Station Copy Pink - Prevention Services
Signature (that all violations have been corrected as noted)
Date
FD2155 (Rev 9/2017)