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Home My WebLink About1830 FLOWER STREETz/ /71 3 KERN BUSINESS FORMS — 1661) 325 -5818 — #6013 UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1: Business Plan and Inventory Program B G R S F I 11 D FIRE D ARTM BAKERSFIELD FIRE DEPT. Prevention Services 2101 H Street Bakersfield, CA 93301 Tel.: (661) 326 -3979 Fax: (661) 852 -2171 FACILITY NAME, INSPECTION DATE INSPECTION TIME 11G 12-1111c> 10' 00 ADDRESS 0 owl 57- .V . /W CA PHONE NO. 3& -2 yoo NO OF EMPLOYEES FACILITY CONTACT 93308 BUSINESS ID NUMBER r,Aa,e %s C /Oy7aAv 32.6 - Business PLAN CONTACT INFORMATION ACCURATE (CCR: 2729.1) Consent to Inspect Name /Title 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 BMC: 15.65.080) IJEc'. 7 0 T c'S •'L iNfo2wl TV T 1V*p' Ce eS U r 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)) Co BNam• LS D A-1 8G L K VERIFICATION OF HAZ MAT TRAINING CCR: 2732) i% I Fly b C'2 Ifez MzT Tee? / 2c= Catiec/ VERIFICATION OF ABATEMENT SUPPLIES & PROCEDURES (CCR: 2731(c)) EMERGENCY PROCEDURES ADEQUATE CCR: 2731) CONTAINERS PROPERLY LABELED CCR: 66262.34(f), CFC: 2703.5) I& HOUSEKEEPING CFC: 304.1) 2t FIRE PROTECTION CFC: 903 & 906) SITE DIAGRAM ADEQUATE & ON HAND CCR: 2729.2) ANY HAZARDOUS WASTE ON SITE? YES V• NO SienatureofReceipt Explain: Nar 2 U57- oC2T,10w 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 1-1 Street, California 93301 White —Business Copy Yellow — Business Copy to be Sent in after return to Compliance G%JC Signature (t at " II vi " tons have been corrected as noted) Date Pink — Prevention Services Copy FD2155 (Rev 6 #10) KERN BUSINESS FORMS - (661) 325 -5818 - #6013 UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1: Business Plan and Inventory Program R S F t 8. 7D FIRE D ARTM BAKERSFIELD FIRE DEPT. Prevention Services 2101 H Street Bakersfield, CA 93301 Tel.: (661) 326 -3979 Fax: (661) 852 -2171 FACILITY NAME INSPECTION DATE INSPECTION TIME COMMENTS vo ADDRESS i PHONE NO. NO OF EMPLOYEES c7 o&je 57- Sa /l 25 J c %/ 0 3& -2 lend FACILITY CONTACT BUSINESS ID NUMBER c_Agie/Fs (f /2 0A av S !b I '? J yi Consent to Inspect Name /Title 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) IJ£ - << io Te wS ifuJ 2o`eTit a CE'f2s V ST irA1 o Business PLAN CONTACT INFORMATION ACCURATE (CCR: 2729.1) VISIBLE ADDRESS CFC: 505.1, BMC: 15.52.020) CORRECT OCCUPANCY CSC: 401) VERIFICATION OF INVENTORY MATERIALS CCR: 2729.3) VERIFICATION OF QUANTITIES CCR: 2729.4) Egr VERIFICATION OF LOCATION CCR: 2729.2) PROPER SEGREGATION OF MATERIAL CFC: 2704.1) VERIFICATION OF MSDS AVAILABILITY CCR: 2729.2(3)(b)) N -17a o s o ti 96V C- _ ,F 3 W VERIFICATION OF HAZ MAT TRAINING CCR: 2732) F ='' ('V`-'2 2 VERIFICATION OF ABATEMENT SUPPLIES & PROCEDURES (CCR: 2731(c)) EMERGENCY PROCEDURES ADEQUATE CCR: 2731) CONTAINERS PROPERLY LABELED CCR: 66262.34(f), CFC: 2703.5) C HOUSEKEEPING CFC: 304.1) 51 . FIRE PROTECTION CFC: 903 & 906) tK SITE DIAGRAM ADEQUATE & ON HAND CCR: 2729.2) ANY HAZARDOUS WASTE ON SITE? YES 15YN0 Signature ofReceiat Explain: Ncrr 37- 5 I oCZ •`d,V P POST INSPECTION INSTRUCTIONS: Correct the violation(s) noted above by Within 5 days of correcting all of the violations, sign and return a copy ofthis page to: Bakersfield Fire Dept., Prevention Services, 2101 H.Street, California 93301 White — Business Copy Yellow — BusinessCopy to be Sent in alleyreturn to Compliance Signature (that • II vi 1bons have been corrected as noted) Z // Date Pink — Prevention Services Copy FD2155 (Rev 6H10) KERN CENTER A OWNED AND OPERATED BY THE COUNTY OF KERN CHARLES CLAYTON LABORATORY MANAGER 661) 326 -2468 1700 Mt. Vernon Ave. Fax (661) 326 -2528 Bakersfield, CA 93306 claytonc@kernmedctr.com xe-lC- FACILITY NAME: s;;_ Section 2: Underground Storage Tanks Program Routine Combined Type of Tank _ Type of Monitoring _ Joint Agency Multi- Agency Number of Tanks Type of Piping 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: /Z-////o Complaint Re- Inspection OPERATION C V COMMENTS Proper tank data on file Proper owner / operator data on file Permit fees current VEIN 5, Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations X Has there been an unauthorized release? Yes' 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 Inspector: aetir6- 1t__1n9%N2 Questions regarding this inspection? Please call us at (661) 326 -3979 White — Prevention Services Pink - Business Copy KBF -7335 FD 2156 (Rev. 09/05)