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HomeMy WebLinkAboutBUSINESS PLAN 5/19/2008I~ 4 PAWS PET HOSPITAL 4201 MEXICALI DR Ma~ 19 08 11:33a Front1 6613971187 p.4 . I UV # J'4^ '",)1/01.1. Vt::L + 4 PAWS PET B SPITAL ==============--==;===-========== SiteID: 015-021-000258 + +=...==========~- -=.====~=====;=====-===============-===_==R======== Fast Format + += Site Emerg cy Factors =;==;==-======~======================== Overall Sit~ + +-.. Spec1al Ha ards -------------::r-____---=--------_.__________________________+ - ----------~-- - --- --------- -------------------------- 1----=====____1____==============================____=-------===-----=-------==1 +=== Utility Sfut-OffS ==========="'.-============================== 08/07/2007 + GAS - SW SIDfOF BLDG ELECTRICAL - NE SIDE OF BLDG WA'l.'ER - SW S E OF BLDG +-;==========='--===========__.._am~~~=======~.a=====:;=====D3~======~~_======;+ +==== Fire Protiec./Avail. Water ========--._-===========_=========~ 12/11/2006 + PRIVATE FIRE PROTECTION - FIRE EXTINGUISHER: 2 AND ONE IN DOG WARD S WALL ONE MAIN HALLWAY BET EXAM 1 & +============"" +===== Buildin I 9-~O YDRANT - 70FT SW CRNR MEXlCALI & SCHIRRA ~~___:==;=====D_~=====~=~~======_~============.=.======~======~~+ Occupancy Level ===..~=====================.======== 03/13/2006 + 9-10 SEASONAL EMPLOYEES 3 EMPLOYEES -..-----=..--=---..."'==---____E:_~0L~l~~f=S_______________.________"'+ - ----- -- --- --------~~~~-=~-- ------------- -------- -5- 04/25/2008 ~` -` '~ 4 PAWS PET HOSPITAL SiteID: 015-021-000258 Manager BETH WIMPEE Location: 4201 MEXICALI DR City BAKERSFIELD BusPhone: (661) 397-3767 Map 123 CommHaz Low Grid: 16C FacUnits: 1 AOV: CommCode: BFD STA 09 EPA Numb: SIC Code:0742 DunnBrad: Emergency Contact / Title Emergency Contact / Title BETH WIMP EE / OFFICE MANAGER MUKAND SANDHU DVM / OWNER Business Phone: (661) 397-3767x Business Phone: (661) 397-3767x 24-Hour Phone (661) 833-6379x 24-Hour Phone (661) 588-7205x Pager Phone ( ) - x Pager Phone (661) 205-3211x Hazmat Hazards: Fire Press React ImmHlth Contact MUKAND SANDHU DVM Phone: (661) 397-3767x MailAddr: 4201 MEXICALI DR State: CA City BAKERSFIELD Zip 93313 Owner MUKAND SANDHU DVM Phone: (661) 588-7205x Address 8201 CAMINO MEDIA State: CA City BAKERSFIELD Zip 93311 Period to TotalASTs: - Gal Preparers TotalUSTs: = Gal Certif' d: RSs : No ParcelNo: Emergency Directives: ~N~D PROG A - HAZMAT ~ ~~' v ~ PROG H - HAZ WASTE GEN ~~©~ E?ergd 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 and believe the information is true, accurate, and c o mplete. / ~ ~1~~~~~5~1 ~t~ ~ ~ ~ ~ ~~ Signature Date -1- 06/29/2007 -, a F 4 PAWS PET HOSPITAL SiteID: 015-021-000258 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpeCHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN WASTE FIXER F P IH G R L 300.00 2.00 FT3 GAL Low Min -2- 06/29/2007 -3- 06/29/2007 F 4 PAWS PET HOSPITAL SiteID: 015-021-000258 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: SURGERY RM CAS# 7782-44-7 ~GasATE T TYPE PRESSURE TEMPERATURE CONTAINER TYPE I Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 300.00 FT3 300.00 FT3 300.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 tiHGL-1KL t~~5r.a~in~lvla TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: SURGERY RM CAS# Liquid TWaste ~ AmbRient~E ~ AmbientT~E ~LASTICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5..00 GAL _ 2.00 GAL 5.00 GAL tltiGtilCL V U .7 1.v1"lrvly r,lv 1.7 °sWt. RS CAS# Silver No 7440224 t1HGL-~ICL H. 7.7P~J.71~1L"1V1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 06/29/2007 n F 4 PAWS PET HOSPITAL SiteID: 015-021-000258 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 07/28/2000 ~ DIAL 911. Employee Notif./Evacuation VERBAL. 12/20/1991 Public Notif./Evacuation VERBAL. 12/20/1991 Emergency Medical Plan 07J28/2000 DIAL 911 AND GIVE FIRST AID AT SCENE. -5- 06/29/2007 i F 4 PAWS PET HOSPITAL SiteID: 015-021-000258 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 12/20/1991 ~ COMPRESSED GAS CYLINDERS SECURED IN PLACE BY CHAINS. Release Containment ~.lcaii vN v~.11ci icc~vui~:c til:l.lVCLl.1V11 -6- 06/29/2007 F 4 PAWS PET HOSPITAL SiteID: 015-021-000258 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ aN~t;lcai na~.ai.u~ Utility Shut-Offs A) GAS - SW SIDE OF BLDG B) ELECTRICAL - NE SIDE OF BLDG C) WATER - SW SIDE OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO 08/27/2002 Fire Protec./Avail. Water 12/11/2006 = PRIVATE FIRE PROTECTION - FIRE EXTINGUISHER: ONE MAIN HALLWAY BET EXAM 1 & 2 AND ONE IN DOG WARD S WALL NEAREST FIRE HYDRANT - 70FT SW CRNR MEXICALI & SCHIRRA Building Occupancy Level 03/13/2006 9-10 SEASONAL EMPLOYEES -7- 06/29/2007 ,~, F 4 PAWS PET HOSPITAL SiteID: 015-021-000258 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 11/03/2006 ~ MSDS SHEET ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: ORAL AND WRITTEN PROGRAM COVERING WORKPLACE HAZARDS. rayC ~ Held for Future Use . l J L - S1C1U 1V1 rui..utc V-~C -8- 06/29/2007 4 PAWS PET HOSPITAL Manager BETH WIMPEE Location: 4201 MEXICALI DR City BAKERSFIELD CommCode: BFD STA 09 EPA Numb: SiteID: 015-021-000258 BusPhone: (661) 397-3767 Map 123 CommHaz Low Grid: 16C FacUnits: 1 AOV: 'SIC Code:0742 DunnBrad: Emergency Contact / Title Emergency Contact / Title BETH WIMPEE / OFFICE MANAGER MUKAND SANDHU DVM / OWNER Business Phone: (661) 397-3767x Business Phone: (661) 397-3767x 24-Hour Phone (661) 833-6379x 24-Hour Phone (661) 588-7205x Pager Phone ( ) - x Pager Phone (661) 205-3211x Hazmat Hazards: Fire Press React ImmHlth Contact MUKAND SANDHU DVM Phone: (661) 397-3767x MailAddr: 4201 MEXICALI DR State: CA City BAKERSFIELD Zip 93313 Owner MUKAND SANDHU DVM Phone: (661) 588-7205x Address 8201 CAMINO MEDIA State: CA City BAKERSFIELD ~ Zip 93311 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs:`No ParcelNo: .Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN ~~° FEe Saaed on my inquiry of those individuals re ~ ~ +?Q0, sponsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. igr ture Date -1- 01/24/2007 q 3. T i~ F 4 PAWS PET HOSPITAL ~ Hazmat Inventory = ~ MCP+DailyMax Order = SitelD: 015-021-000258 ~ By Facility Unit ~ Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F P IH G 300.00 FT3 Low WASTE FIXER R L 2.00 GAL Min -2- 01/24/2007 t P~ ~ ~ -3- 01/24/2007 ? 5 .. '~• F 4 PAWS PET HOSPITAL SiteID: 015-021-000258 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: SURGERY RM CAS# 7782-44-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 300.00 FT3 300.00 FT3 300.00 FT3 tit~Gl-1ttLVUJ ~vt~lrvlvr.lvlJ oWt. RS CAS# 100.00 Oxygen, Compressed No 7782447 t1HGLj.tCL H.7J~,JJ1~1~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low ~ Inventory Item 0002 Facility Unit: Fixed .Containers on Site ~ COMMON NAME / CHEMICAL NAME WASTE FIXER Days On Site 365 Location within this Facility Unit Map: Grid: SURGERY RM CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TWaste ~ Ambient ~ Ambient _~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum DailyAverage 5.00 GAL 2.00 GAL 5.00 GAL - I1tiGlitCLVU.7 ~:V1~lYV1V~1V1J °sWt. RS CAS# Silver No 7440224 t1HGa'-1KL H.J.7L" .7.71~iL' 1V 1.7 TSecret RS BioHaz .Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R / / / Min -4- 01/24/2007 n ~ ~ F 4 PAWS PET HOSPITAL SiteID: 015-021-000258 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 07/28/2000 ~ DIAL 911. Employee Notif./Evacuation 12/20/1991 VERBAL. Public Notif./Evacuation VERBAL. 12/20/1991 Emergency Medical Plan 07/28/2000 DIAL 911 AND GIVE FIRST AID AT SCENE. -5- 01/24/2007 F-t~ 7'i F 4 PAWS PET HOSPITAL SiteID: 015-021-000258 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 12/20/1991 ~ COMPRESSED GAS CYLINDERS SECURED IN PLACE BY CHAINS. tCC1Cd5C l.Uill.d111IllClll. ~.lcc~aa U~/ v~.aaci nc~vul.~.c r~~:~..LVa~.lvaa -6- 01/24/2007 -. :~_ .- F 4 PAWS PET HOSPITAL SiteID: 015-021-000258 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ especial riazarus Utility Shut-Offs 08/27/2002 A) GAS - SW SIDE OF BLDG B) ELECTRICAL - NE SIDE OF BLDG C) WATER - SW SIDE OF BLDG D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 12/11/2006 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHER: ONE MAIN HALLWAY BET EXAM 1 & 2 AND ONE IN DOG WARD S WALL NEAREST FIRE HYDRANT - 70FT SW CRNR MEXICALI & SCHIRRA Building Occupancy Level 9-10 SEASONAL EMPLOYEES 03/13/2006 -7- 01/24/2007 -...:~`• F 4 PAWS PET HOSPITAL SiteID: 015-021-000258 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 11/03/2006 ~ MSDS SHEET ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: ORAL AND WRITTEN PROGRAM COVERING WORKPLACE HAZARDS. rctyC a LIC ll.4 1VL CU4 LL1C U.7C Held for Future Use -8- 01/24/2007 '!:a, `~.. • ~` -'~~'" CITY OF 13AI{ERSFIELD FIRE DEPARTMENT b~ OFFICE OF ENV1RONli'IENTAL SERVICES "~ UNIFIED PROGRAM INSPECTION CHECKLIST :w ~g~,d~~~ 1715 Chester Ave., 3rd I±Ioor, Bakersfield, CA 93301 ~uuu~ 1/ FACILITY NAME~_~~w ~ ~~"~' ~ / ~S'PECTION DATE i t', 02 0 ~ ADDRESS ,2 / r cA~! .e. PHONE NO. 7 - ~ ? FACILITY CONTACT a A~u v BUSINESS ID NO. _ 15-210-0~ INSPECTION TIME y ~~~- ~,.~ ~ ti ~ NUMBER OF EMPLOYEES ~~ ___. ~~6~ Section 1: Business Plan and Inventory Program ~~.J ^ Combined ^ Joint Agency ^hulti-Agency ^ Complaint ^ Re-inspection • OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate • hh Visible address + Nv Correct occupancy Verification of inventory materials Qx (?'~ G . 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 `~~j~ ~~~ Any hazardous waste on site?: es ^ No • Explain: - ~Q ~ .ov ' Questions regarding is inspection? Please call us at (661) 326-3979 sYs~ f5 tiOT ~1~ Bustness Stte Responsible Party White -Env. Svcs. Yellow -Station Copy Pink -Business Copy Inspector: A. ~/~ ~`T~ ~,~ n , 5 ~ ~n UNIFIED PROGRAM INSPECTION CHECKLIST;; _. .. ...... - _. _._,_,_. _.._~... .Y. ._~Jt SECTION 1: Business Plan and Inventory Program B E R S F I D F/RE ARTM T Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 AGILITY NAME `~ /~ INSPECTION DATE INSPECTION TIME ADDRESS ~ PHONE NO. NO OF EMPLOYEES ~ FACILITY ONTA BUSINESS ID NUM61 5 ~ ~ G- ~02~ ~ `Sg - ~ - Section 9. Qusiriess Plan-and Iltventory Program. ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE J ^ VISIBLE ADDRESS .C ~ / .KI ^ CORRECT OCCUPANCY r: ^ VERIFICATION OF INVENTORY MATERIALS ' ' ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL t~ ^ VERIFICATION OF MSDS AVAILABILITY {l V ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES L~ ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING -/ 1G ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ner-oui~ ANY HAZARDOUS WASTE ON SITE? `_ YES ^ NO EXPLAIN: ~~~ C~~~~ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 D~ Inspector (Please Print) Fire Prev ntion / 1~~ In /Shift of Site/Station # ~Lsin ss SlY~esponsible rty (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09105 r Yj + 4 PAWS PET HOSPITAL _________________________________ SiteID: 015-021-000258 + Manager MINOI HAVENER Location: 4201 MEXICALI DR City BAKERSFIELD BusPhone: (661) 397-3767 Map 123 CommHaz Low Grid: 16C FacUnits: 1 AOV: CommCode: BFD STA 09 EPA Numb: SIC Code:0742 DunnBrad: Emergency Con ct ~ ~, Title Emergency Contact / Title ETH ~ FICE MANAGER MuxAND SANDHU / OWNER Business Phone: (661) 397-3767x Business Phone: (661) 397-3767x 24-Hour Phone (661) 833-6379x 24-Hour Phone (661) 588-7205x Pager Phone ( ) - x Pager Phone ( 661) fr3-;~- Hazmat Hazards: Fire Press React ImmHlth Contact MUKAND SANDHU Phone: (661) 397-3767x MailAddr: 4201 MEXICALI DR State: CA City BAKERSFIELD Zip 93313 Owner MUKAND SANDHU DVM Phone: (661) 588-7205x Address 8201 CAMINO MEDIA State: CA City BAKERSFIELD Zip 93311 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ PROG A - HAZMAT PROG H - HAZ WASTE GEN E~j~ ~~ -~ z ?p46 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 and believe the information is true, accurate, and complete. ignature Date ~~ ~ ~ 5~~ -1- 06/01/2006 n Fo ~~i +.4 PAWS PET HOSPITAL _________________________________ SiteID: 015-021-000258 + Manager MINOI HAVENER Location: 4201 MEXICALI DR City BAKERSFIELD BusPhone: (661) 397-3767 Map 123 CommHaz Low Grid: 16C FacUnits: 1 AOV: CommCode: BFD STA 09 EPA Numb: SIC Code:0742 DunnBrad: ------------------------------- ------ ------------------------ ------------ E3ergency Cont~~~~/ Title ~ Emergency Contact / Title ~ OFFICE MANAGER MUKAND SANDHU / OWNER Business Phone: (661) 397-3767x Business Phone: (661) 397-3767x 24-Hour Phone (661) 833-6379x 24-Hour Phone (661) 588-7205x Pager Phone ( ) - x Pager Phone (661) 637-4726x Hazmat Hazards: Fire Press React ImmHlth Contact MUKAND SANDHU Phone: (661) 397-3767x MailAddr: 4201 MEXICALI DR State: CA City BAKERSFIELD Zip 93313 Owner MUKAND SANDHU DVM Phone: (661) 588-7205x Address 8201 CAMINO MEDIA .State: CA City BAKERSFIELD Zip 93311 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No _ ParcelNo: - Emergency Directives: ~ PROG A - HAZMAT PROG H - HAZ WASTE GEN ENT'D A U G 2 ~ 2006 Based on my inquiry of those individuals responsibip for obtaining 4he information, I Certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete, ignature ~ `` ~/~ Date ~~~~ 1~~1 -1- 03/13/2006 UNIFIED PROGRAM INSPECTION CHECKLIST r= ?#at%.~~k'3r~R.:a ~~. 'LGti^*&-.v, ~~i" '.i. ih~.Y >~:..... ,:>~.~3 'a ..,.. .~. W'sa ,.--. ... .3.w _,1..", c '.5:3- a~'.:?R ':_. ez~~A': SECTION ~1: Business Plan and Inventory Program .G • BAKERSFIELD FIRE DEPT Prevention Services ~~~~ 9001Yuxtun Ave., Suite 210 ~wr~r r Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME ~ S ~ ~ - `"l l~ NSPECTION DATE . U' '-~~ INSPECTION TIME ~ T s ~ os r r ~ vc- ADDRESS pp~~~~ `~ HO~ ~i ~ ~~ ~ 3 O OF~¢APLOYEES ~ ~J (~ ~ i r l~ X C~4- C S.~ / FACILIT ONTACT 1e- 5" ~ ~~~~z~~ USINESS ID NUMBER 15-021- Z..~ ~ Section 1: Business Plan and Inventory Program ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION • C V (~=Compliances OPERATION V-Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIfI@SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS $ ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES 4~ ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ~^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ;0" ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE i£ ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES I~~fdO EXPLAIN: ~UESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (667) 326-3978 I W ~ ~1~~ ~ Inspector (Please Print) Fire Proven on / 1b` In /Shift of Site/Station ~ Busi Site/School Sfte Re ponsible Party (Please Print) White -Prevention Services Yellow -Station Copy Pink - Buaineas Copy FD2049 (Rev. 02/05) UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 -- FACILITY NAME INSPECTION DATE INSPECTION TIME ADDRESS ~ PHONE No. Na. of Employees --`'I~o1-- m~=X'-c<<1------Q~--------_ ------------ -------p~T--2-X003--- 3H~~ 367 --- _~_------- FACILITYI;ONTACT Business ID Number rn; ~ l 15-021- eoo zs Section 1: Business Plan and Inventory Pn~gram L~Routine ^ Combined ^ Joint Agency ^Mutti-Agency ^ Complaint ^ Re-inspection C ® V ^ ^ (C=Compliance OPERATION ~ V=Violation APPROPRIATE PERMIT ON HAND BUSINESS PLAN CONTACT INFORMATION ACCURATE COMMENTS ® ^ VISIBLE ADDRESS ® ^ CORRECT OCCUPANCY ® ® ^ ^ VERIFICATION OF INVENTORY MATERIALS VERIFICATION OF QUANTITIES ® ^ VERIFICATION OF LOCATION ® ^ PROPER SEGREGATION OF MATERIAL ® ^ VERIFICATION OF MSDS AVAILABILITYE ® ^ VERIFICATION OF HAT MAT TRAINING ® ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ® ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ® ^ HOUSEKEEPING ^ FIRE PROTECTION Q,) ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE: ~ YES ^ NO EXPLAIN: i QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT ~st)'I ~ 326-3979 1 Inspector Badge No. Business Site Responsible Party White -Environmental Services Yellow -Station Copy Pink -Business Copy ~~ ~~