HomeMy WebLinkAboutBUSINESS PLAN 8/16/2005f. / /
UNITED REFRIGERATION INC
SiteID: 015-021-000099
Manager GRANT PIPKIN
Location: 230 E 21ST ST
City BAKERSFIELD
CommCode: BFD STA 02
EPA Numb:
BusPhone: (661) 322-1100
Map 103 CommHaz Moderate
Grid: 29A FacUnits: 1 AOV:
SIC Code:5078
DunnBrad:
Emergency Contact / Title Emergency Contact / Title
GRANT PIPKIN / MANAGER MIKE SULLIVAN / COUNTER SALES
Business Phone: (661) 322-1100x Business Phone: (661) 322-1100x
24-Hour Phone (661) 343-0863x 24-Hour Phone (661) 319-6918x
Pager Phone ( ) - x Pager Phone ( ) - x
Hazmat Hazards: Fire Press React ImmHlth DelHlth
Contact GRANT PIPKIN Phone: (215) 698-9100x
MailAddr: 11401 ROOSEVELT BLVD State: PA
City PHILADELPHIA Zip 19154-2197
Owner UNITED REFRIGERATION INC Phone: (215) 698-9100x
Address 11401 ROOSEVELT BLVD State: PA
City PHILADELPHIA Zip 19154-2197
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif ' d: RSs : No
ParcelNo:
Emergency Directives:
PROG A - HAZMAT
~
~ ~'~~'
Based on my inquiry ofi those individuals
responsible for obtaining the information, I certify
under penalty of law thaf I have personally
examined and am familiar with the information
submitted and believe the information is true,
accur te, ~. d co pl .
~ - ~ 4-07
Signature Date
-1- 10/18/2007
F UNITED REFRIGERATION INC SiteID: 015-021-000099 ~
~ Hazmat Inventory By Facility Unit ~
~ MCP+DailyMax Order Fixed Containers on Site ~
Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP
TY-ION C70 DH L 80.00 GAL Mod
FREON 22 F P R IH G 15178.00 FT3 Low
FREON 502 F P R IH G 8294.00 FT3 Low
OXYGEN F P IH G 256.00 FT3 Low
FREON 12 F P R IH G 400.00 LBS Min
-2- 10/18/2007
-3- 10/18/2.007
r
F UNITED REFRIGERATION INC SiteID: 015-021-000099 ~
~ Inventory Item 0013 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
TY-ION C70 Days On Site
365
Location within this Facility Unit Map: Grid:
MID NE WHSE N WALL CAS#
107-21-1
LiTAid Mixture AmbRent~E AmbientTURE CONTAINER TYPE
qu~ T ~- ~ OTHER - SPECIFY
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
GAL 80.00 GAL 40.00 GAL
HAZARDOUS COMPONENTS
%Wt. RS CAS#
10.00 Ethylene Glycol No 107211
0.50 Potassium Hydroxide No 1310583
r1tiL~tiRL Y.J .7P~JJ1~1P~1V 1.7
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies DH / / / Mod
~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
FREON 22 Days On Site
365
Location within this Facility Unit Map: Grid:
N RM CAS#
75-45-6
STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Gas TMixture Above Ambient Ambient PORT. PRESS. CYLINDER
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum . I Daily Average
558.00 FT3 15178.00 FT3 10714.00 FT3
ilALl!].C<LVVwJ t.V1~1J:'V1V P~1V 1w7
%Wt. RS CAS#
100.00 Chlorodifluoromethane No 75456
r1t~L~tu[.L tiJ .7IJ a7 J1.1L'1V 1.7
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F P R IH / / / Low
-4- 10/18/2007
F UNITED REFRIGERATION INC SiteID: 015-021-000099 ~
~ Inventory Item 0003 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
FREON 502 Days On Site
365
Location within this Facility Unit Map: Grid:
N RM CAS#
76-15-3
~GasATE TMixtur~-AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER
AMOUNTS AT THIS LOCATION
Largest Co432100rFT3 Daily8294100m FT3 I Daily4147r00e FT3
1zs~c,ruu.ivuJ ~.vllrvivr~ly t J
cwt. Rs cAS#
100.00 Chlorodifluoromethane No 75456
L1HGtitCL HJ JP~JJ1~11;1V1J
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F P R IH / / / Low
~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
OXYGEN Days On Site
365
Location within this Facility Unit Map: Grid:
NW CRNR OF BLDG CAS#
7782-44-7
~GasATE TPureE ~AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
256.00 FT3 256.00 FT3 160.00 FT3
iu-~uruu~v~a ~vt~irvlvJ;tvt.7
%Wt• RS CAS#
100.00 Oxygen, Compressed No 7782447
i-lt~[~CSCCL tiJ JP~J Jl"1L'1V1J
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F P IH / / / Low
-5- 10/18/2007
F UNITED REFRIGERATION INC
~ Inventory Item 0001
COMMON NAME / CHEMICAL NAME
FREON 12
Location within this Facility Unit
INSIDE BLDG N SIDE CNTRL LOCKED RM
STATE T TYPE ~~ PRESSURE _
Gas I Mixture I Above Ambient
SiteID: 015-021-000099 ~
Facility Unit: Fixed Containers on Site ~
Days On Site
365
Map: Grid:
CAS#
75-71-8
TEMPERATURE CONTAINER TYPE
Ambient PORT. PRESS. CYLINDER
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum ( Daily Average
11.03 LBS 400.00 LBS 400.00 LBS
tiAGKKLUUS C:Ut~lr~lv~lv~1~5
%Wt. RS CAS#
100.00 Dichlorodifluoromethane No 75718
nt~~r~xL tiaa~5~in~ivl~
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F P R IH / / / Min
-6- 10/18/2007
r ,
F UNITED REFRIGERATION INC SiteID: 015-021-000099 ~
Fast Format ~
~ Notif./Evacuation/Medical Overall Site ~
~ Agency Notification 09/21/2000 ~
CALL 911.
Employee Notif./Evacuation 05/08/2007
CALL 911 AND EVACUATE THE BLDG.
NOTE: WE ONLY HAVE 3 EMPLOYEES, WE HAVE 3 EXITS AND VERBALLY OR USE PA TO
NOTIFY EMPLOYEES.
Public Notif./Evacuation 09/21/2000
IN CASE OF FIRE DIAL 911 TO NOTIFY FIRE DEPT.
Emergency Medical Plan 05/08/2007
MERCY HOSPITAL, 2215 TRUXTUN AVE, 632-5000.
-7- 10/18/2007
F UNITED REFRIGERATION INC SiteID: 015-021-000099 ~
Fast Format ~
~ Mitigation/Prevent/Abatemt Overall Site ~
~ Release Prevention 04/03/1990 ~
WE CONFORM TO CAL OSHA STANDARDS FOR STORAGE. EMPLOYEES ARE INSTRUCTED IN
SAFE HANDLING OF HAZARDOUS MATERIALS.
Release Containment 05/08/2007
CLEAR AREA AND NOTIFY OTHERS, CALL 911 IF NECESSARY.
Clean Up 05/08/2007
COMPLIANT WITH MANUFACTURERS RECOMMENDATIONS OF SPECIFIC MATERIAL.
v~.iici itG~VU1L.C t~t..~..1va~..lv11
-8- 10/18/2007
F UNITED REFRIGERATION INC SiteID: 015-021-000099 ~
Fast Format ~
~ Site Emergency Factors Overall Site ~
aYC~:iai nct~aiu5
Utility Shut-Offs 05/08/2007
GAS - NW CRNR OF WHSE
ELECTRICAL - NE CRNR OF BLDG REAR E SIDE
WATER - METER N OF BLOCK IN ALLEY
Fire Protec./Avail. Water
PRIVATE FIRE PROTECTION - 2 FIRE EXTINGUISHERS.
FIRE HOSE INSIDE WHSE CNTRL S SIDE.
05/08/2007
Building Occupancy Level 02/28/2006
3 EMPLOYEES
-9- 10/18/2007
F UNITED REFRIGERATION INC SiteID: 015-021-000099 ~
Fast Format ~
~ Training Overall Site ~
~ Employee Training 11/06/2006 ~
MATERIAL SAFETY DATA SHEETS ON FILE.
BRIEF SUMMARY OF TRAINING PROGRAM: HAZARD CLASS, HAZARD COMMUNICATION
BOOKLET AND MSDS SHEETS KEPT IN BOOKLET IN OFFICE. WE GO OVER SPILLS AND
DISPOSAL OF MATERIALS.
rayc ~
iic.iu ivi r u~uLC vac
racl.u ivl ru~uic vac
-10- 10/18/2007
~,~JNITEl~ REFR GERATION INC SiteID: 015-021-000099
~iL/+~~ ~~~Ki~
Manager ~"i~ 'T~n..~ BusPhone: (661) 322-1100
Location: 230 E 21ST ST Map 103 CommHaz Moderate
City BAKERSFIELD Grid: 29A FacUnits: 1 AOV:
CommCode: BFD STA 02
EPA Numb:
SIC Code:5078
DunnBrad:
Emergency Contact / Title Emergency Contact / Title
/ MANAGER ® / COUNTER SALES
Business Phone: (661) 322-1100x Business Phone: (661) 322-1100x
24-Hour Phone (661) ~~~ 24-Hour Phone (661) c
Pager Phone ( ) 3y 3- o8fi3c ~ Pager Phone
Hazmat Hazards: Fire Press React ImmHlth DelHlth
Contact GRANT PIPKIN Phone: (215) 698-9100x
MailAddr: 11401 ROOSEVELT BLVD State: PA
City PHILADELPHIA Zip 19154-2197
Owner UNITED REFRIGERATION INC Phone: (215) 698-9100x
Address 11401 ROOSEVELT BLVD State: PA
City PHILADELPHIA Zip 19154-2197,
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
Emergency Directives:
~ ~ ~ ~ S~c.~~ ~~~
PROG A - HAZMAT
2~ ~~~Q 3l~ -~qr8
Eased on my inquiry of those individuals
respnnsib!e for obtaining the information, I certify
under penalty of la~v that I have personally
examined and am familiar with the information
submitted and believe the information is true,
accur e, nd complete.
/1 312D
f
Signature Date [[T
LN I ~Q ~~ q
ICI ~~ Q ~ r?Q~/
-1- 02/20/2007
F,IJNITEI~ REFRIGERATION INC SiteID: 015-021-000099 ~
~ Hazmat Inventory By Facility Unit ~
~ MCP+DailyMax Order Fixed Containers on Site ~
Hazmat Common Name,.. SpecHaz EPA Hazards Frm DailyMax Unit MCP
TY-ION C70 ~ DH L 80.00 GAL Mod
FREON 22 F P R IH G 15178.00 FT3 Low
FREON 502 F P R IH G 8294.00 FT3 Low
OXYGEN F P IH G 256.00 FT3 Low
FREON 12 F P R IH G 11430.00 FT3 Min
o
T
APp~dx
SAME
~iCCE~ 2i2
2 p p ro moo L65
_ 6 ~ 5 ~Tr
-2-
02/20/2007
-3- oa/ao/aoo~
F UNITEL REFRIGERATION INC SiteID: 015-021-000099 ~
~ Inventory Item 0013 Facility Unit: Fixed Containers on Site ~
COMMON-NAME / CHEMICAL NAME
TY-ION C70 Days On Site
365
Location within this Facility~Unit Map: Grid:
~~~"' CAS #
J'h 1 DQG ~ /~ E . ~/AeEL/dd 5 ~ ~Gerr1 6t/.4G.G. 10 7 - 21-1
STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Liquid Mixture Ambient ~ Ambient OTHER.- SPECIFY
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
GAL 80.00 GAL 40.00 GAL
$Wt rt1iG[-~1:cLVUa 1:V1~lYV1VL'~Nl'S
. RS CAS#
10.00 Ethylene Glycol No 107211
0.50 Potassium Hydroxide No 1310583
TSecret
RS
BioHaz ti.'~GS•ittl! A5ar;55M1J'N'1'~
Radioactive/Amount EPA Hazards
NFPA
USDOT#
MCP
No No No No/ Curies DH / / / Mod
~ Inventory Item 0002 Facility Unit: Fixed Containers on. Site ~
COMMON NAME / CHEMICAL NAME
FREON 22 Days On Site
365
Location within this Facility Unit Map: Grid:
N RM CAS#
75-45-6
~GasATE TMixtur~AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
558.OO~FT3 15178.00 FT3 10714.00 FT3
- ntiGtilct~VUJ 1.V1~lYV1V1~;1V~1~5
$Wt. RS CAS#
100.00 Chlorodifluoromethane No 75456
ri[~GtiKl! A~5r:5~Mr;N'1'~
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F P R IH / / / Low
~~
-4- 02/20/2007
F UNITEL REFRIGERATION INC SitelD: 015-021-000099 ~
~ Inventory Item 0003 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
FREON 502 ~ Days On Site
..365
Location within this Facility,Unit Map: Grid:
N RM CAS#
STATE T TYPE ~- PRESSURE _
Gas I Mixture I Above Ambient
76-15-3
TEMPERATURE CONTAINER TYPE _
Ambient PORT. PRESS. CYLINDER
AMOUNTS AT THIS LOCATION
Largest Co432100rFT3 Daily8294100m FT3 I Daily4A47r00e FT3
-•• tlAGHtL11VU~ C:UMYVNr;N•1.5
sWt. RS CAS#
100.00 Chlorodifluoromethane No 75456
t1HGHKIJ ASS~~SMr:N'1'~
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F P R IH / / / Low
~ Inventory Item 0004 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
OXYGEN ~ Days On Site
365
Location within this Facility Unit Map: Grid:
NW CRNR OF BLDG CAS#
7782-44-7
STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE =
Gas ~ure Above Ambient Ambient PORT. PRESS. CYLINDER
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
256.00 FT3 256.00 FT3 160.00 FT3
tiAGHK1JV U5 I:VMYVN~N'1•~
~Wt. RS CAS#
100.00 Oxygen, Compressed No 7782447
t1AGHKU AS~r+~~Mr+N•1•~
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F P IH / / / ,Low
V~ I
-5- 02/20/2007
F UNITED REFRIGERATION INC SiteID: 015-021-000099 ~
~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
FREON 12 Days On Site
365
ation within this Facility~Unit Map: Grid: CAS#
~"~(5~ v ~ UV ~.1 ..JG aer ~ Ccx~r rD ci~i~'~. 7 5 - 71- 8
~GasATE ~ TYPE ~AboveSAmbEient TEMPERATURE CONTAINER TYPE
Mixture ~ Ambient PORT. PRESS. CYLINDER
AMOUNTS P,T THIS LOCATION
Largest Container Daily Maximum Daily Average
397.00 FT3 1130.00 FT3 7620.00 FT3
t1AG.yKUUU~ C;UMYUN~N'1'S
oWt. RS CAS#
100.00 Dichlorodifluoromethane No 75718
HHL,HKJJ A~~~SSM~N'1'S
TSecret RS BioHaz Radioactive/Amount EPA Hazards 11TFPA USDOT# MCP
No No No No/ Curies F P R IH / / / Min
~~~4~ ~e~
2 c~v c 3S
1 0
(,ADO
~~~~
~F ~~~ ~ ~~~ its
,M,A.,c .
-6- 02/20/2007
F,UNITEI~ REFRIGERATION INC SiteID: 015-021-000099 ~
Fast Format ~
~ Notif./Evacuation/Medical Overall Site ~
~ Agency Notification 09/21/2000 ~
CALL 911.
Employee Notif./Evacuation 11/06/2006
CALL 911 AND EVACUATE THE BLDG.
NOTE: WE ONLY HAVE ~ EMPLOYEES, WE HAVE 3 EXITS AND VERBALLY NOTIFY
EMPLOYEES. ~
3 1~EQ6 A ~ f - ~? ~ . ,
Public Notif./Evacuation 09/21/2000
IN CASE OF FIRE DIAL 911 TO NOTIFY FIRE DEPT.
Emergency Medical Plan 11/06/2006
MERCY HOSPITAL, 2215 TRUXTUN AVE, 327-3371.
-7- 02/2.0/2007
~_UNITE~'h REFRIGERATION INC SiteID: 015-021-000099 ~
Fast Format ~
~ Mitigation/Prevent/Abatemt ~ Overall Site ~
~ Release Prevention 04/03/1990 ~
WE CONFORM TO CAL OSHA STANDARDyS FOR STORAGE. EMPLOYEES ARE INSTRUCTED IN
SAFE HANDLING OF HAZARDOUS MATERIALS.
Release Containment n ../I
~L~AQ ~/-~2EA NdT~ ~~ o;r+E~25 ar4c. ~i/ iF
l~~S,42y.
,.
Clean Up
~OM ~G 1 A ~uT
~+~rF2~at, .
WtTLI M ~ ~d N TV ~G Q r"IN~E~ DATIOn/ ~ C9F SP€~~ FiL
ac eE S ~
Other Resource Activation
-8- 02/20/2007
F;UNITE~ REFRIGERATION INC SitelD: 015-021-000099 ~
Fast Format ~
~ Site Emergency*Factors Overall Site ~
5peciai tiazaras
r
Utility Shut-Offs 11/06/2006
Nctl Ca,v2 ~r W,q,~{u~s~
A) GAS -
B) ELECTRICAL - ~CRNR OF BLDG REAR ~I~. C2~~2 dF f~LOlr ~cQ~ ~sr ~D~
C) WATER- METER N OF BLOCK IN ALLEY
D) SPECIAL - NONE
E) LOCK BOX - NO
Fire Protec./Avail. Water 11/06/2006
PRIVATE FIRE PROTECTION - 2 FIRE EXTINGUISHERS.
F~BFi.._8YL1Pd~+l'£ ruTr•n ~
FiQ~ (-~as+~ ~r~s-4E (I~Aet~lDvS CE~7e~~ So . siv~
Building Occupancy Level 02/28/2006
3 EMPLOYEES
-9- 02/20/2007
~~
e•
F'UNITEb REFRIGERATION INC SiteID: 015-021-000099 ~
Fast Format ~
~ Training Overall Site ~
~ Employee Training 11/06/2006 ~
MATERIAL SAFETY DATA SHEETS ON FILE.
BRIEF SUMMARY OF TRAINING PROGRAM: HAZARD CLASS, HAZARD COMMUNICATION
BOOKLET AND MSDS SHEETS KEPT IN BOOKLET IN OFFICE. WE GO OVER SPILLS AND
DISPOSAL OF MATERIALS.
0
rayC ~
..
nciu LUL ruuure u5~
ncs.u ivi. rut.ui.c vac
-10- 02/20/2007
Prevention Services
UNIFIED PROGRAM INSPECTfON CHECKLIST B A FRS F 1 D 900Truxtun-Ave., Suite 210
_.
_~~~.~.~,,,~e._ ~~.,~,~~~ ,~~~.,,~_~ ~.~.~ .~~,- u..~_,..._...._
Fi,>Q,E Bakersfield, CA 93301
SECTION 1: Business Plan and Inventory Program i°Rr"' - Tel.: (66I) 32x=3979-
- - - - ~ Fax: (661) 872-217.1
L~3' ROUTINE
Section 1: Business Plan and Inventory Program: fll
^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION
FACILITY NAME ~ - - INSPECTION DATE INSPECTION TIME
t,G,~tr,Trr it~~ -rL/G ~-~a~ ~~vc 9 - 2C --~G //OU
ADDRESS
2 30 ~ . 2.~ s~ PHONE NO.
3ZZ- llo~ O OF EMPLOYEES
~
FACILITY CONTACT -
I BUSINESS ID NUMBER - ~ -
15-021- OQ(~~~'
C V ~ C=Compliance OPERATION
V=Violation COMMENTS
~~ ^ APPROPRIATE PERMIT ON HAND
.IJ ^ BUSIt1eSS PLAN CONTACT INFORMATION ACCURATE b
^ VISIBLE ADDRESS
^ CORRECT OCCUPANCY
^ VERIFICATION OF INVENTORY MATERIALS
^ VERIFICATION OF QUANTITIES
^ VERIFICATION OF LOCATION
^ PROPER SEGREGATION OF MATERIAL
~/
~
Q
^ VERIFICATION OF MSDS AVAILABILITY
~
/
CJ
^ VERIFICATION OF HAZ'MAT TRAINING
1
YJ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
^ EMERGENCY PROCEDURES ADEQUATE
Pf ^ CONTAINERS PROPERLY LABELED
^ HOUSEKEEPING
^ FIRE PROTECTION ,,[ y' ~7 ~1,/ /~~,/~,/,~
t [i Cam. ~ ///~ I (/ J i L -~/G~WII/t~Y
^ SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITE? ^ YES ~YNO
EXPLAIN:
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (667) 326-3979
~` ~~rNo~vy ~ ~~~~ Z~4
Inspector (Please Print) Fire Prevention / 1s' In /Shift of Site/Station #
~ r~!
White -Prevention Services ~ Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05
Bakersfield Fire Dept.
UNIFIED PROGRAM INSPECTION CHECKLIST 'Environmental Services
SECTION 1 Business ,Plan and invento Pro ram 900 Truxtun Ave., suite 210
rY 9 Bakersfield, CA 93301
Tel: X661) 326-3979
FACILITY NAME INSPECTION DATE INSPECTION TIME
uN ~TiL.rJ_ -----2~~r~,~Gr~__•_r_ria~c~ --- _ -------- -- _ . - - £~-%-"~--- ! yeo /d.~ y~
ADDRESS - + S T _ .... ,-_._._ _.__ ... _ . PHONE No. No. of Employees
Z 3d l~ Z l ~ 3ZZ°1/?~D _ _~ _ ___
8ueiness ID Number
FACILITVCONTACT
~~~J i ~ /"~fl®/:/ 15-021- f~lXXl91
Section 1: Business Plan and Inventory Pn~gram
Routine O Combined O Joint Agency ~ Multi-Agency O Complaint ~ Re-inspection
• QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT 661 326-3979
Inspector (Please Print) Fire Prevention 1st-IMShiN of Site Business de esponsible rty (Please Print)
YYhHe -Environmental Services Yelkriv - Station Copy Pink -Business Copy ,