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UNIFIED PROGRAM INSPECTION CHECKLIST
Prevention
0'rru t
n Services
to Z_ o 900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
SECTION 1: Business Plan and Inventory Program
r Tel.: (661) 326 -3979
Fax: (661) 872 -2171
FACILITY NAME _ INSPECTION DATE INSPECT TIME
ADDRESS PHON NO. O OF EMPLOYEES
a
ROUTINE COMBINED JOINT AGENCY MULTI - AGENCY COMPLAINT
FACILITY CONTACT BUSINESS ID NUMBER
15 -021- 4a r9
C v COMMENTS
Section 1: Business Plan and Inventory Program
APPROPRIATE PERMIT ON HAND
11 ROUTINE COMBINED JOINT AGENCY MULTI - AGENCY COMPLAINT RE- INSPECTION
C v c C= Compliance OPERATION
V= Violation
COMMENTS
Q'' APPROPRIATE PERMIT ON HAND
Q-13 Business PLAN CONTACT INFORMATION ACCURATE
D -" VISIBLE ADDRESS
CORRECT OCCUPANCY
VERIFICATION OF INVENTORY MATERIALS
C5 VERIFICATION OF QUANTITIES
O-- VERIFICATION OF LOCATION
PROPER SEGREGATION OF MATERIAL
9,-' VERIFICATION OF MSDS AVAILABILITY
VERIFICATION OF HAZ MAT TRAINING
y VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
13,-' EMERGENCY PROCEDURES ADEQUATE
CONTAINERS PROPERLY LABELED
HOUSEKEEPING
FIRE PROTECTION'
O
P,-- SITE DIAGRAM ADEQUATE & ON HAND
neroui.
ANY HAZARDOUS WASTE ON SITE?
EXPLAIN:
YES O
QUESTIONS REGARDIN IS INSPECTION? PLEASE CALL US AT (661) 326 -3979
A
a Iry
Inspector (Please Print) Fire Prevention / 1" In / Shift of Site /Station # Bu §mess Site / Responsible Party (Please Print)
White — Prevention Services Yellow - Station Copy Pink — Business Copy FD 2155 (Rev. 09/05