HomeMy WebLinkAboutBUSINESS PLAN 9/14/2006L~~~_I
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Prevention Services
UNIFIED PROGRAM INSPECTION CHECKLfST R F R 5 e , . „ 900 Truxtun-Ave., suite 210
FARE Bakersfield, CA 93301
SECTION 1:.~usiness Plan and Inventory Program "Rr'" T ~ Te1.: (661) 326-3979
Fax: (661) 872-2171
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FACILITY NAME -
i ( INSPECTION DATE
~7 - ~~(- INSPECTION TIME t
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ADDRESS ~ ~
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~ ^H~O-NE NO. O OF EMPLOYEES
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FACILITY~ONTACT ` ~
~ BUSINESS ID NUMBER
15-021-
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~~ROUTINE
Section 1: Business Plan and Inventory Program
^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT
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^ RE-INSPECTION
C V ~ C=Compliance .OPERATION
V=Violation COMMENTS
^ APPROPRIATE PERMIT ON HAND
~' ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE
'Q"- ^
(
_ VISIBLE ADDRESS N Q V ,2 1 2006
~
^ CORRECT OCCUPANCY
VERIFICATION OF INVENTORY MATERIALS ~r~-CT' ~~,~CILJ
^ VERIFICATION OF QUANTITIES
.Q' ^ VERIFICATION OF LOCATION
I,~" ^
(( PROPER SEGREGATION OF MATERIAL o0
^ VERIFICATION OF MSDS AVAILABILITY
,~[` ^
( VERIFICATION OF HAZ MAT TRAINING
~~ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
^ EMERGENCY PROCEDURES ADEQUATE
^ CONTAINERS PROPERLY LABELED
~` ^ HOUSEKEEPING
~? ^ FIRE PROTECTION
L~}' ^ SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITE?
EXPLAIN:
~~ ~- 7C'ID '~' 11P
^ YES ^ NO
Inspector (Please Print) Fire Prevention / 1s~ In /Shift of Site/Station #
- White -Prevention Services - _ Yellow -Station Copy ~ Pink -Business Copy
FD 2155 (Rev. 09/05
+ TIME WARNER TELECOM _________________________________ SiteID: 015-021-002933 +
Manager BusPhone: (503) 416-1892
Location: 1025 18TH ST Map 103 CommHaz Low
City BAKERSFIELD Grid: 30C FacUnits: 1 AOV:
CommCode: BFD STA O1 SIC Code:4899
EPA Numb: DunnBrad:
Emergency Contact / Title Emergency Contact / Title
RANDY BROSCHAT / N~.~o~koperts.~'to~s G~h-~,r'
Business Phone: (503) 47L6~-1892x Business Phone: ( ) - x
24-Hour Phone (360) 60T-4711x 24-Hour Phone ($OO)829 -042Ox
Pager Phone ( ) - x Pager Phone ( ) - x
Hazmat Hazards:
Contact Phone: (503) 416-1892x
MailAddr: 5205 SW SIXTH AVE 300 State: OR
City PORTLAND Zip 97204
Owner Phone: (503) 416-1892x
Address 5205 SW SIXTH AVE 300 State: OR
City PORTLAND Zip 97204
Period to TotalASTs: = Gal
Preparer : ~,,,,d~, g~-pxL~'~ TotalUSTs : = Gal
Certif'd: RSs: No
ParcelNo:
Emergency Directives:
PROG A - HAZMAT
PROG T - ABOVEGROUND STOI.'AGE TANK
406
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,
urate, an mplete.
319-~0~
Signature Date
-1- 02/28/2006
UNIFIED PROGRAM INSPECTION CHECKLIST
~~
SECTION 1 Business .Plan and Inventory Program
/~ Bakersfield Fire Dept.
~/ Environmental Services
`~'"~"` 900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
Te_I: (661} 326-3979 __ _
ADDRESS ~_
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~--r., INSPECTION ATE
_ ~,
PHONE No.
r~~G_y[ ---- __L ------ -
ID Number
~s-o2l-t~bz~-3Z
Section 1: Business Plan and Inventory Program
outine ^ Combined O Joint Agency ^Multt-Agency ^ Complaint ^ Re-inspection
C V \V=Voatonnce} OPERATION COMMENTS
^ C~, APPROPRIATE PERMIT ON HAND
^ BUSINESS PLAN CONTACT INFORMATION ACCURATE
•
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^
VISIBLE ADDRESS
^
CORRECT OCCUPANCY _. .._.
- -
-
--
RIFICATION OF INVENTORY MATERIALS
- -._ .. ... - -- --_. _ _~. ..
~ ~ r~-~/v_ .. /.". ~ .
F ._.__...
^ VERIFICATION OF QUANTITIES _/ ~/ __r`1_ l ~1, ~~ ~~ _ _/~
^ . VERIFICATION OF LOCATION ~ ~ ~ ~
~
' J n A
^
PROPER SEGREGATION OF MATERIAL _ ._ ..__ .._... .__ . V
" ~.
^ VERIFICATION OF MSDS AVAILABIIITYE ~~
-=o ~I
.
~ 0
~ ^ VERIFICATION OF HAT MAT TRAINING -
.
-- ... ..........__...._ . .
^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
^ --._....__. _._....__._ -
EMERGENCY PROCEDURES ADEQUATE _ T..._. _...._.
~
~' ^ CONTAINERS PROPERLY LABELED
^ HOUSEKEEPING
/~
^•
FIRE PROTECTION .. --
~ _ _ - -
^ SITE DIAGRAM ADEQUATE S ON HAND
ANY HAZARDOUS WASTE ON SITE?: ^ YES I~NO
EXPLAIN: ~6d~~~~^ ~l'iJ"(OKJ~- ~ I ~' 1 .oA- SIT-/f~ /'tY
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QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT ~66~~ 326-399
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-- -- ----- .,~~--~._~ __ _ _ _- ----- ~-----1 _ _ _
Inspector (Please Print) Fire Prevention 1st-In/S ite
Business Site R spon Party (Please Print)
While • Environmental Services Yellow -Station Copy Pink -Business Copy
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