HomeMy WebLinkAbout1200 coffee bp 7-9-13KERN BUSINESS FORMS - (661)325 -5818- #6013
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U.NWhED PROGRAM INSPE"CTWN CK ECKLIST F,RE
2101 'H Street Y
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PCO earn Tel..: (661 - '326- 3979
SECTION . .BUMriess Plan and "Invento g
Fax:. - (:661 }:852- 21°72
INSP.ECTIONDATE INSPECTION' TIME
FACILITY NAME
'.... `;. PHONE NO.' NO OF EMPLOYEES ..
`ADDRESS-
r� _G
BUS NES'S ID NUMBER .
FACILITY' CONTACT
Consent to Inspect Name /Title
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- ❑ ,ROUT.INE. � COMBINED ❑ .:JOINT AGENCY ❑ MULTI= AGENCY , .. ` ❑ 'COMPLAINT ❑' RE- INSPECTION
C V ( C= Compliance " O P E RAT I ON, . C O M'M E N TS
�V= Violation
❑ ARPROPRIATE"PERMIT ON HAND (BMC:" 15.65.080)
❑' BUSIneSS -PLAN CONTACT,INFORMATION ACCURATE .(CCR, 2729.1)
t ` CFC:,505.1, 'BMC: 1.5.52:020) "
❑. VISIBLE ADDRESS' (
❑, CORRECT OCCUPANCY.. (CBC: 401.)
❑'
VERIFICATION OF
-INVENT
.ORY,MATERIALS (CCR: 2729.3)
❑: VERIFICATION -OF QUANTITIES (CCR:.2729.4)
❑- VERIFICATION OF LOCATION
(CCR: 2729 2)
❑ PROPER°SEGREGATION OF MATERIAL (CFC: 2704 1)
❑ VERIFICATION OF MSDS AVAIL`ABI'LITY (CCR: 2729.2(3)(b))
. ❑ VERIFICATION' OF HA
MAT TRAINING (CCR: 2732)
k VERIFICATIONOFABATEMENT .SUPPLIES" &.PROCEDURES (CCR:2731(c))'
EMERGENCY. PROCEDURES ADEQUATE (CGR: 2731)
CONTAINERS`PROP,ERLYlABELED (CCR° 6626234(f), CFC: 2703.5)
❑� HOUSEKEEPING'
(CFC: 304 1)
+ r .�
FIRE P.ROTECI ION (CFC:,903 & 906)i " ,,,..�
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>� f *',' /i•:"f >Si
El SITE DIAGRAM ADEQUATE & ON HAND (CCR: 2729.2)`���
Si2natiireofReceipt. `
ANY HAZARDOUS WASTE O:N SIT?E? YES.
Explain
.POST INSPECTION INSTRUCTIONS:
ation s " -noted above by Signature(that all violations Yave:been corrected as noted)
o . Correct the viol (, )
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