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UNIFIED PROGRAM INSPECTION CHECKLIST e a s F, n
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SECTION 1: Business Plan and Inventory Program "Rrer r
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Prevention Services
900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
Tel.: (661) 326 -3979
Fax: (661) 872 -2171
FACILITY NAME
Ll U;
INSPECTION DATE
INSPECTION TIME
ADDRES
1,660 / '
ONE NO.
6 716 -7600
NO OF EMPLOYEES
2 a
FACILITY CONTA T
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vBusiness
USINESS ID NUMBER
Section 1s: 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
C C I_ . S I: ' t •�'
PLAN CONTACT INFORMATION ACCURATE
S � 'tC -L 31)3// 3 � Q A J/
11 71
1 ❑
VISIBLEADDRESS
( ❑
CORRECT OCCUPANCY
❑
VERIFICATION OF INVENTORY MATERIALS
J
AS ❑
VERIFICATION OF QUANTITIES
❑
VERIFICATION OF LOCATION
❑
PROPER SEGREGATION OF MATERIAL
�I ❑
VERIFICATION OF MSDS AVAILABILITY
F ❑
VERIFICATION OF HAZ MAT TRAINING
❑
VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
❑
EMERGENCY PROCEDURES ADEQUATE
1� ❑
CONTAINERS PROPERLY LABELED
❑
HOUSEKEEPING
El
FIRE PROTECTION
y.W
`y. ❑
SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITE? ❑ YES Rd NO
EXPLAIN:
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326 -3979
Inspector (Please P"Int) Fire Prevention / 1" In /Shift of Site /Station # Business Sife 2esponsi6 a Frrty (Please Print)
While - Prevention Services Yellow - Station Copy Pink - Business Copy FO 2155 (Rev. 09/05