HomeMy WebLinkAboutBUSINESS PLANCITY OF BAKERSFIELD FIRE DEPARTMENT
OFFICE OF ENVIRONMENTAL SERVICES
UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3r'~ Floor, Bakersfield, CA 93301
FACILITY NAME C:~
ADDRESS 3~ ~'"O
FACILITY CONTACT
INSPECTION TIME
Section 1:
'~outine
Business Plan and Inventory Program ~ f~
~ Combined ~ Joint Agency [~ Multi-Agency ~l Complaint [~ Re-inspection
OPERATION C V COMMENTS
Appropriate permit on hand
Business plan contact information accurate
Visible address
Correct occupancy
Verification of inventory materials
Verification of quantities
Verification of location
Proper segregation of material
Verification of MSDS availability
Verification of Haz Mat training
Verification of abatement supplies and procedures
Emergency procedures adequate
Containers properly labeled
Housekeeping
Fire Protection
Site Diagram Adequate & On Hand
C=Compliance V=Violation ~ \
Any hazardous waste on site?: [~1 Yes ~No
ExPlain:
Questions regarding this inspection? Please call us at (661) 326-3979
White - Env. Svcs. Yellow - Station Copy Pink - Business Copy
Busines~ S~e Responsible Party
Inspector: {'~ ~ ,,xh~ 5
INSPECTION DATE !/~3
PHONE NO. ~'~- -
BUSINESS ID NO. 15-210-
NUMBER OF EMPLOYEES
OFFICE OF ENVIRONMENTAL SERVICES
171'5 Chester Ave., CA 93301 (661) 326-3979
BUSINESS NAME (Same as ~ACILI~ N~E or DBA- Doing' Busin~ ~) 3 BUSINESS PHONE ~02
SITE ADDRESS
CITY
DUN &
BRADSTREET
· CA
106
103
ZIP lo5
SiC CODE 107
(4 Digit #)
COUNTY ~oe
OWNER NAME 1~ I OWNER PHONE 112
OWNER MAILING
ADDRESS
113
CITY
114 STATE ~ls ZIP 116
CONTACT NAME
117 CONTACT PHONE
CONTACT MAILING
ADDRESS
119
CITY 120 STATE 121 ZIP 122
123 NAME
TITLE
125
TITLE
129
130
BUSINESS PHONE 126 BusINESS PHONE 131
24-HOUR PHONE 127 24-HOUR PHONE 132
PAGER # 128 PAGER # 133
NAMES OF OVVNER/OPERATOR (print)
Certification: Based on my inquiry of those individuals responsible for obtaining the Information, I certify under penalty of law that I have personally examined
and am familiar with the Information submitted In this inventory and believe the information is true, accurate, and complete.
SIGNATURE OF OWNER/OPERATOR ] DATE..~ /~..Z:~./(..2? 134 I NAME OF DOCUMENT.~- ~/r'~'/~'~'PREPARER
136I TITLE OF OWNERJOPERATOR
273O (3/~J)