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UNIFIED PROGRAM INSPECTION CHECKLIST
Haz-Mat Business Plan and Inventory Program
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BAKERSFIELD FIRE DEPT.
Prevention Services
0.5F1 LD
FIRE 2101 H Street
ARTM r Bakersfield, CA 93301
Tel.: (661) 326 -3979
Fax: (661) 852 -2171
FACILITY NAME
INSPECTION DATE
INSPECTION TIME
ADDRESS
—t
t
PHONE NO.
NO OF EMPLOYEES
FACILITY CONTACT
BUSINESS ID NUMBER
Consent to Inspect
4
Name /Title
4
Section 1: Hazardous Materials Business Plan and inventory Program
ROUTINE ❑ COMBINED ❑ JOINTAGENCY
❑ MULTI - AGENCY ❑ COMPLAINT ❑ RE- INSPECTION
C
V
C= Compliance OPERATION
V= Violation
COMMENTS
0.
❑
VISIBLE ADDRESS (CFC: SOS.t,BMC: 15.52.020)
S ^ f�
G5 } �
�
D;
❑
APPROPRIATE PERMIT ON HAND
(BMC: 15.65.080)
//'�
////&//3 /t/o/ /4c-C ee cG'
❑
[V
CERS UPDATED FOR THE CURRENT CALENDAR YEAR
(H &S 25404(e)
/� y
C
O
❑
BUSINESS PLAN CONTACT INFORMATION ACCURATE
(CCR:2729.4)
❑
❑
VERIFICATION OF INVENTORY MATERIALS
(CCR: 2729.3)
D.
❑
VERIFICATION OF QUANTITIES
(CCR: 2729.4)
❑.
❑
VERIFICATION OF LOCATION
(CCR: 2729.2)
❑
❑
PROPER SEGREGATION OF MATERIAL
(CFC: 5004.1)
Q-
❑
SAFETY DATA SHEET AVAILABILITY
(CCR: 2729.2(3)(b))
❑
❑
VERIFICATION OF HAZ MAT TRAINING
(CCR: 2732)
D
❑
VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES (CCR:2734 (c))
❑
❑
EMERGENCY PROCEDURES ADEQUATE
(CCR: 2731)
❑
❑
CONTAINERS PROPERLY LABELED (CCR: 66262.34 (1); CFC: 50015)
❑
❑;
HOUSEKEEPING
(CFC: 304.1)
❑' .
❑
FIRE PROTECTION
(CFC: 903 & 906)
<- it
❑:'
❑
SITE DIAGRAM ADEQUATE & ON HAND
(CCR: 2729.2 13))
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NY HAZARDOUS
WASTE ON SITE? _W YES ❑
NO
xpialn:
.ALt_b (h11�° — GI
Signature of Receipt:
A .itr w �'(l
POST INSPECTION INSTRUCTIONS FOR RETURN -TO- COMPLIANCE:
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
Signature (that all violations have been corrected as noted)
Date
White — Business Copy Yollom— Business Ce, to be Seel in nne,,etem to Con,honee Pink Prevention Services Copy M2155 (Roo 1114)