HomeMy WebLinkAbout4700 COFFEE ROAD (10)UNIFIED PROGRAM INSPECTION CHECKLIST
SECTION 1: Business Plan and Inventory Program
FACILITY NAME
o 6 s;
Prevention Services
HJDAR S f' a. D 900 Truxturt Ave., Suite 210
RE Bakersfield, CA 93301
R-TN Tel.: (661) 326 -3979
V Fax: (661) 872 -2171
FACILITY NAME
o 6 s;
INSPECTION DATE
7 Zy .
INSPECTION TIME
ADDRESS PHONE NO. NO OF EMPLOYEES
00 Co S ' / b
FACILITY CONTACT 933/ Z USI SS ID NUMBER
15 -021-
Section 1: Business Plan and Inventory Program
ROUTINE COMBINED JOINT AGENCY MULTI- AGENCY COMPLAINT RE- INSPECTION
C V c C= Compliance) OPERATION
V= Violation
COMMENTS
APPROPRIATE PERMIT ON HAND
BUSIneSS PLAN CONTACT INFORMATION ACCURATE
VISIBLE ADDRESS °
CORRECT OCCUPANCY
VERIFICATION OF INVENTORY MATERIALS
VERIFICATION OF QUANTITIES
VERIFICATION OF LOCATION
G PROPER SEGREGATION OF MATERIAL
VERIFICATION OF MSDS AVAILABILITY
VERIFICATION OF HAZ MAT TRAINING
VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
Y EMERGENCY PROCEDURES ADEQUATE
X CONTAINERS PROPERLY LABELED u decd L2,616'5 7f- 57-2VZ7—gz7U2- 912ybi
6wNP (J1
El HOUSEKEEPING
FIRE PROTECTION
JQ, SITE DIAGRAM ADEQUATE & ON HAND T_
ANY HAZARDOUS WASTE ON SITE?
EXPLAIN: Z - SS 0221 • R,
I L[67
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326 -3979
lL l1! qa
Inspector (Please Print) Fire Prevention 11" 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
UNIFIED'PROGRAM INSPECTION CHECKLIST
SECTIOIy 1: Business Plan and Inventory Program.
FACILITY NAME
I
INSPECTION TIME
COMMENTS
ADDRESS
Prevention Services
B K n R S IT , 0, , D 900 Truxtun Ave., Suite 210 .
FIRE Bakersfield, CA 93301
D I ARFM
v Tel.: (661) 326 -3979
Fax:
VISIBLE ADDRESS
661) 872 -2171
FACILITY NAME INSPECTION DATE INSPECTION TIME
COMMENTS
ADDRESS PHONE NO. NO OF EMPLOYEES
i
Business PLAN CONTACT INFORMATION ACCURATE
FACILITY CONTACT I S ID NUMBER
VISIBLE ADDRESS
15-021 -
r
Section 1: Business Plan and Inventory Program
ROUTINE rQ; COMBINED JOINT AGENCY MULTI - AGENCY COMPLAINT RE- INSPECTION
C v C= Compliance OPERATION
V= Violation
COMMENTS
APPROPRIATE PERMIT ON HAND
L Business PLAN CONTACT INFORMATION ACCURATE
R VISIBLE ADDRESS
CORRECT OCCUPANCY
1
VERIFICATION OF INVENTORY MATERIALS
Q VERIFICATION OF QUANTITIES
Q- VERIFICATION OF LOCATIONN'
PROPER SEGREGATION OF MATERIAL
VERIFICATION OF MSDS AVAILABILITY
VERIFICATION OF HAZ MAT TRAINING
VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
F F EMERGENCY PROCEDURES ADEQUATE
I CONTAINERS PROPERLY LABELED 4.7 -716 S S r2/Z7— oz7c
HOUSEKEEPING
FIRE PROTECTION
SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITES?
EXPLAIN: 2. - 5- a2 ! F5.
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326 -3979
L
Inspector `(Please Print) - -FirePrevention / 1" In / Shift of Site /Station # Business Site /'R sponsible Party (Please Print)
White — Prevention Services Yellow - Station Copy Pink — Business Copy FD 2155 (Rev. 09/05
me-7- S4 /l
FACILITY NAME: Co
f3at4!9R5 .W1 M g33iz
Section 2: , Underground Storage Tanks Program
Routine
T
Combined
Type o ank _
Type of Monitoring _
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326 -3979
Fax: (661) 852 -2171
Page 1 of 1
INSPECTION DATE: % 2Vho
Joint Agency Multi- Agency Complaint Re- Inspection
Number of Tanks
Type of Piping
OPERATION C V
INSPECTIONS
Proper tank data on file
JARTMRSF I B_ L D
BUSINESS PLAN & T
INVENTORY PROGRAM
Certification of Financial Responsibility
UNIFIED PROGRAM INSPECTION CHECKLIST
me-7- S4 /l
FACILITY NAME: Co
f3at4!9R5 .W1 M g33iz
Section 2: , Underground Storage Tanks Program
Routine
T
Combined
Type o ank _
Type of Monitoring _
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326 -3979
Fax: (661) 852 -2171
Page 1 of 1
INSPECTION DATE: % 2Vho
Joint Agency Multi- Agency Complaint Re- Inspection
Number of Tanks
Type of Piping
OPERATION C V COMMENTS
Proper tank data on file
Proper owner / operator data on file
Permit fees current
Certification of Financial Responsibility
Monitoring record adequate and current
Maintenance records adequate and current
Failure to correct prior UST violations
Has there been an unauthorized release? Yes x No
Section 3: Aboveground Storage Tanks Program
Tank Size(s)
Type of Tank
Aggregate Capacity
Number of Tanks
OPERATION Y N COMMENTS
SPCC available
SPCC on file with OES
Adequate secondary protection
Proper tank placarding /labeling
Is tank used to dispense MVF ?)
If yes, does tank have overfill / overspill protection?
C = Compliance V = Violation Y = Yes N = No
Questions regarding this inspection? Please call us at (661) 326 -3979
White — Prevention Services
Business Site Responsible Party
Pink - Business Copy
KBF -7335 FD 2156 (Rev. 09/05)