HomeMy WebLinkAbout13703 VIA LA MADERA HMBP 2.13.15 (2)aRFN BAKERSFIELD FIRE DEPT.
Prevention Services
UNIFIED PROGRAM INSPECTION CHECKLIST 2101 HStreet
::::......::..:.: :. ::.:..,...:.:::.::.:: :::., .:..:.::::...... .......:.:.:...:...:.:......... Bakersfield, CA 93301
HaZ -Mat Business Platt and Inventory Program Tel.: (661) 326 -3979
g Fax: (661) 852 -2171
FACILITY NAME
g �C`
INSSP CTI N DATE
INSPECTION TIME
ADDRESS
-�. G °;
PHONt NO. f
NO OF EMPLOYEES
FACILITY CON
ACT
BUSINESS ID NUMBER
Consent to Insp
ct Name /Title
ROUTINE ❑ COMBINED ❑ JOINT AGENCY ❑ MULTI - AGENCY ❑ COMPLAINT ❑ RE- INSPECTION
COMMENTS
M
Signature (that all violations have been corrected as noted)
Date
White —Business Copy Yellow .— Business Copy to be Sent in after return to Compliance Pink Prevention Services Copy
FD2155 (Rev 1/14)
C V (
t,= uompuance) OPERATION
V= Violation
"" ❑ VIISiBLE
ADDRESS (CFC: 505.1, BMC: 15.52.020)
❑
IPPROPRIATE PERMIT ON HAND (BMC: 15.65.080)
❑ CERS
UPDATED FOR THE CURRENT CALENDAR YEAR (H &S 25404(e)
1 ❑ BUSINESS
PLAN CONTACT INFORMATION ACCURATE (CCR: 2729.1)
❑ ❑ VERIFICATION
OF INVENTORY MATERIALS (CCR: 2729:3).
❑ ❑ V.RIFICATIONOFQUANTITIES
(CCR: 2729.4)
�}
❑ ❑ VI
RIFICATION OF LOCATION (CCR: 2729.2)
❑ ❑ P
OPER SEGREGATION OF MATERIAL (CFC: 5004.1)
❑ ❑ SAFETY
DATA SHEET AVAILABILITY (CCR: 2729.2(3)(b))
❑ ❑ VERIFICATION
OF HAZ MAT TRAINING (CCR: 2732)
❑ ❑ VERIFICATION
OF ABATEMENT SUPPLIES AND PROCEDURES (CCR:2731(c))
❑ ❑ EMERGENCY
PROCEDURES ADEQUATE (CCR: 2731)
❑ ❑ CpNTAINERS
PROPERLY LABELED (CCR: 66262.34 (f); CFC: 5003.5)
❑ ❑ HOUSEKEEPING
(CFC: 304.1)
❑ ❑ FIRE
PROTECTION (CFC: 903 & 906)
❑ ❑ S�E DIAGRAM ADEQUATE & ON HAND (CCR: 2729.2(3))
ANY HAZARDOUS WASTE ON SITE? ❑ YES ❑ NO
Explain:
Si natul
POSTAN•SPECTIOJNSTRUCTIONS
* Correct the v
• Within 5 days
Bakersfield
FOR RETURN -TO- COMPLIANCE:
olation(s) noted above by
of correcting all of the violations, sign and return a copy of this page to:
ire Dept., Prevention Services, 2101 H Street, California 93301
COMMENTS
M
Signature (that all violations have been corrected as noted)
Date
White —Business Copy Yellow .— Business Copy to be Sent in after return to Compliance Pink Prevention Services Copy
FD2155 (Rev 1/14)