HomeMy WebLinkAbout3600 DE SOUZA STE A_FARZAD MOGHADDAM DDS HMBP 6.21.22UNIFIED PROGRAM INSPECTION CHECKLIST
SECTION 1: Hazardous Materials Business Plan
Inspection
C #-00' 1 L I _�> (0 6
ctm V P, M
BAKERSFIELD FIRE DEPT.
Prevention Services
2101 H Street
° 04 Bakersfield, CA 93 301
Tel.: (661) 326-3979
Fax: (661) 852-2171
FACILITY NAME INSPECTION DATE INSPECTION TIME
ADDRESS HONE NO. NO OF EMPLOYEES
0 0 (1 i - 6'3 W/ - '2>6 15�
FACILITY CONTACT iUSINESS ID NUMBER
V61 1A elL o o -L1 - 6y 11 06
Consent to Inspect Name/Title
Al
Section 1: Business Plan and Inventory Program
ROUTINE ❑ COMBINED ❑ JOINT AGENCY ❑ MULTI -AGENCY ❑ COMPLAINT ❑ RE -INSPECTION
C V C=Compliance OPERATION
C E R S
V=Violation; I, I I Minor
Violation COMMENT
,/1 APPROPRIATE PERMIT ON HAND (BMC: 15.65.080)
3010001
CERS INFORMATION ENTERED & UPDATED ANNUALLY (CCR: 2729.1)1
1010008
VISIBLE ADDRESS (CFC: 505.1. BMC: 15.52.020)
CORRECT OCCUPANCY (CBC: 4C
V
- FARZAD MOGHADDAM, D.D.S., M.S.
VERIFICATION OF INVENTORY MATERIALS (CCR: 2729. 3600 De Souza PI. Ste. A
Bakersfield, CA 93309 }�
(661) 834-3600
VERIFICATION OF QUANTITIES
(CCR: 2729.
VERIFICATION OF LOCATION (CCR: 2729. HAS AN APPOINTMENT ON
PROPER SEGREGATION OF MATERIAL (CFC: 2704.
DATE DAY TIME
VERIFICATION OF SDS AVAILABILITY (CCR: 2729.2(3)(b) We reserve the right to charge for appointments
— cancelled or broken without 24 hours advance notice.
VERIFICATION OF HAZ MAT TRAINING (CCR: 273,-
%
V
VERIFICATION OF ABATEMENT SUPPLIES & PROCEDURES (CCR: 2731(c))
EMERGENCY PROCEDURES ADEQUATE (CCR: 2731)
1010010
CONTAINERS PROPERLY LABELED (CCR: 66262.34(f), CFC: 2703.5)
3030007
HOUSEKEEPING (CFC: 304.1)
`
FIRE PROTECTION (CFC: 903 & 906)
3 030032
V
�
SITE DIAGRAM ADEQUATE & ON HAND (CCR:2729.2)
1010005
ANY HAZARDOUS WASTE ON SITE? YES ❑ NO
Signature of Receipt
Explain:
Inspector:��I ( ( t 1 f` S
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: Signature (that all violations have been corrected as noted)
Bakersfield Fire Dept., Prevention Services, 2101 H Street, California 93301
Date
White — Prevention Services Yellow — Station Copy Pink — Business Copy
FD2155 (Rev 3/2019)