HomeMy WebLinkAbout1125 COFFEE ROAD (14)UNIFIED PROGRAM INSPECTION CHECKLIST
SECTION 1: Business Plan and Inventory Program
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BAKERSFIELD FIRE DEPT.
Prevention Services
2101 H Street
Bakersfield, CA 93301
Tel.: (661) 326 -3979
Fax: (661) 852 -2171
FACILITY NAME
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INSPECTION DATE INSPECTION TIME
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ADDRESS
2 S aI c/ I
PHONE NO.
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NO OF EMPLOYEES
FACILITY CONTACT 930 BUSINESS ID NUMBER
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Consent to Inspect Name/Title
MIIII V ' CPe
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Section 1: Business Plan and Inventory Program
ROUTINE COMBINED JOINT AGENCY MULTI - AGENCY COMPLAINT RE- INSPECTION
C v C= Compliance) OPERATION
V= Violation
COMMENTS
APPROPRIATE PERMIT ON HAND (BMC: 15.65.080)
Business PLAN CONTACT INFORMATION ACCURATE (CCR: 2729.1)
VISIBLE ADDRESS (CFC: 505.1, BMC: 15.52.020)
CORRECT OCCUPANCY (CBC: 401)
VERIFICATION OF INVENTORY 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 AVAILABILITY (CCR: 2729.2(3)(b))
VERIFICATION OF HAZ MAT TRAINING (CCR: 2732)
VERIFICATION OF ABATEMENT SUPPLIES & PROCEDURES (CCR: 2731(c))
EMERGENCY PROCEDURES ADEQUATE (CCR: 2731)
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CONTAINERS PROPERLY LABELED (CCR: 66262.34(f), CFC: 2703.5)
HOUSEKEEPING (CFC: 304.1)
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FIRE PROTECTION (CFC: 903 & 906)
SITE DIAGRAM ADEQUATE & ON HAND (CCR: 2729.2)
ANY HAZARDOUS WASTE ON SI'T'E ?? RYES NO
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Signature of Receipt
Explain:
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POST INSPECTION INSTRUCTIONS:
Correct the violation(s) noted above by
Within 5 days ofcorrecting all ofthe violations, sign and return a copy of this page to:
Bakersfield Fire Dept., Prevention Services, 2101 H Street, California 93301
i JS 6 -Cc A : Ci4'ViG ED iva
White — Business Copy Yellow — Business Copy to be Sent in after return to Compliance
Signature (that all violations have been corrected as noted)
Date
Pink — Prevention Services Copy FD2155 (Rev 6//10)
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KERN BUSINESSBUSINESS FORMS - (661) 325 -5818 - #6013
UNIFIED PROGRAM 4NSPECTION CHECKLIST
SECTION 1: Business-Plan and Inventory Program
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BAKERSFIELD FIRE DEPT.
Prevention Services
2101 H Street
Bakersfield, CA 93301
Tel.: (661) 326 -3979
Fax: (661) 852 -2171
FACILITY NAME
v c= Compliance_ OPERATION
V= Violation
INSPECTION DATE
1012-9110
INSPECTION TIME
19 : Z'D _7n
ADDRESS
2
57
EE t aI x-/61 CA!
PHONE NO.
61,19 sS-,-r- `1o6&
NO OF EMPLOYEES
FACILITY CONTACT
CCR: 2729.1)
BUSINESS ID NUMBER
D/5 -21- no/5a Z
Consent to Inspect Name /Title NA Ad SU UlAMA t f ul. r/
CORRECT OCCUPANCY CBC: 401)
VERIFICATION OF INVENTORY MATERIALS CCR: 2729.3)
Section 1: Business Plan and Inventory Program
ROUTINE COMBINED JOINT AGENCY MULTI- AGENCY COMPLAINT RE- INSPECTION
C v c= Compliance_ OPERATION
V= Violation
COMMENTS
APPROPRIATE PERMIT ON HAND.. BMC: 15.65.080)
Business PLAN CONTACT INFORMATION ACCURATE CCR: 2729.1)
VISIBLE ADDRESS (CFC: 505.1, BMC: 15.52.020)
CORRECT OCCUPANCY CBC: 401)
VERIFICATION OF INVENTORY 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 AVAILABILITY CCR: 2729.2(3)(b))
VERIFICATION OF HAZ MAT TRAINING CCR: 2732)
VERIFICATION OF ABATEMENT SUPPLIES & PROCEDURES (CCR: 2731(c))
EMERGENCY PROCEDURES ADEQUATE CCR: 2731)
CONTAINERS PROPERLY LABELED (CCR: 66262.34(f), CFC: 2703.5)
HOUSEKEEPING CFC: 304.1)
FIRE PROTECTION CFC: 903 & 906)
fY SITE DIAGRAM ADEQUATE & ON HAND CCR: 2729.2)
ANY HAZARDOUS WASTE ON SITE? PEES
A<e
NO Signature of Receipt
yj-
Explain:
POST INSPECTION INSTRUCTIONS:
Correct the violation(s) noted above by
Within 5 days of correcting all of the violations, sign and return a copy of this page to:
Bakersfield Fire Dept. Prevention Services, 2101 H Street, California 93301
1iUSpECTE : iQAliG MEDirva
White — Business Copy Yellow — Business Copy to be Sent in after return to Compliance
Signature (that all violations have been corrected as noted)
Date
Pink — Prevention Services Copy FD2155 (Rev 6//10)
FACILITY NAME: 1 7
Section 2: Underground Storage Tanks Program
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:
Routine Combined Joint Agency Multi- Agency Complaint Re- Inspection
Type f Tank owrC S Number of Tanks 3
Type of Monitoring GSM Type of Piping n WF
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 jl
Has there been an unauthorized release? Yes XNo
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
Inspector: EKN C Am 4es
Questions regarding this inspection? Please call us at (661) 326 -3979
White — Prevention Services
Business siteXespdrdible Party
Pink - Business Copy
KBF -7335 FD 2156 (Rev. 09/05)