HomeMy WebLinkAboutBUSINESS PLANCENTRAL BALLEY PULMONARY MED G~
ii 192517TH STR~~'T
~~y~~~D p~~~ CITY OF BAKERSFIELD FIRE DEPARTMENT ~~ 1fl~3
~ ~ OFFICE OF ENVIRONMENTAL SERVICES ~OV
~' •'~ UNIFIED PROGRAM INSPECTION CHECKLIST
1715 Chester Ave., 3'd Floor, Bakersfield, CA 93301
FACILITY NAME~~~~'f'~~ ~ ~il~~ ,~~~M • INSPECTION DATE__/ / - / ~- ~' ~
ADDRESS / 9 ~ S /'7 sf- PHONE NO. ~~"~ - s`3P%
FACILITY CONTACT .S~s~ ~. Gnu 4~1.1~ ~ BUSINESS tD NO. 15-210- 26 ~o
INSPECTION TIME /S ,....~'~..,, Nt_IIViBFR OF EMPLOYEES~,L,
Section 1: Business Plan and Inventory Program
,~ Routine ^ Combined ^ Joint Agency ^Mu1ti-Agency (] Complaint ^ Re-inspection
OPERATION C V COMMENTS
Appropriate permit on hand
Business plan contact information accurate J
Visible address J +.,k t•'•"G.~-'"" /}//7~ C' Q/ ~/)f Q/~
Correct occupancy J / ~ (~ _ ~,~~~~ /~
Verification of inventory materials ~ ,y r..K. y- ~ ~ ;' y ;;~~~
Verification of quantities J '~'«' `~'`'~~ ~'~•~~-/
Verification of location f>~7;;,,~~~~
r,,f ,~. ~ „ ,.
r ~.: , ._
Proper segregation of material ''`~ ~' ' ~-' ! ~,~
..-,,~_, ,Y,. ,
Verification of MSDS availability
Verification of Haz Mat training
Verification of abatement supplies and procedures J
Emergency procedures adequate ~ ~/,rC L CGXi ~ S~ ~ ~~~:~ r sa. X/'
Containers properly labeled ~..
Housekeeping J
Fire Protection f '~
Site Diagram Adequate & On Hand J
C=Compliance V=Violation
Any hazardo s wa eon site?: Y ^ No
Explain: ~ a ~ .f c ~ t~
Questions regarding this inspection? Please call us at (661) 326-3979
Whier -Env. Svcs. Yellow -Station Copy Pink -Business Copy
B siness S' a esponsible Party
Inspector: '
' ~1 ,
CENTRAL VALLEY PULMONARY MED GRP
Manager
Location: 1925 17TH ST
City BAKERSFIELD
CommCode: BFD STA O1
EPA Numb:
OFc 1 g'~o
SiteID: 015-021-0022706=
BusPhone: (661) 327-5301
Map 102 CommHaz Low
Grid: 25D FacUnits: 1 AOV:
SIC Code:8011 3'
c~ ~-~-3 ~
DunnBrad: ~~
Emergency Contact / Title Emergency Contact / Title
TIM RAINBOLT / /
Business Phone: (661) 327-5301x, Business Phone: ( ) - x
24-Hour Phone ( ) - x 24-Hour Phone ( ) - x
Pager Phone ( ) - x ~ Pager Phone ( ) - x
Hazmat Hazards: ~ '1 U Fire React ImmHlth DelHlth
Contact TIM RAINBOLT e ) Phone
(661) 327-5301x
MailAddr: 1925 _17TH ST ~
~l
/
/ :
State: CA
City BAKERSFIELD (
~
v Zip ..93301
Owner / Phone: ( ) - x
Address 1925 17TH ST / (~~ State: CA
City BAKERSFIELD /9 ~j
V Zip 93301
Period to
TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif' d: ~ ~ ~
,~ /(
_ RSs : No
ParcelNo: ~
~' v ~~
O~ ~ !~ ~~
Emergency Directives: ~~`~
~V( ~. ~~ `J r v v
~ Hazmat Inventory One Unified List ~
~ Alphabetical Order All Materials at Site ~
Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP
OXYGEN F IH DH G 1000.00 FT3 Low
WASTE FIXER R L 5.00 GAL Min
-1- 05/10/2005