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UNIFIED PROGRAM INSPECTION CHECKLIST
- SECTION 1: Business Plan and Inventory Program
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Prevention Services
A n R s F , . „ 900 Truxtun -Ave., Suite 210
.FIRE Bakersfield, CA 93301
ARTM r Tel.: (661) 326-3979
Fax: (661) 872-2171
FACILITY NAME _
buS~ y . ~ r2 Cl,~dino ~irJG INSPECTION DATE
>f - Z~ -oC INSPECTION TIME
f/DU
ADDRESS ~' ~~ !~~ PH01J~ ~ _ ^~ ~ NO O~ PLOYEES
FACILITY CONTACT - ~ ~
.~ t! Z a h vt e. ~rn t ~'~ BUSINESS ID fJUMBER -
~ 15-021- DOOD
_- - - - - _
Section 1: Business Plan and Inventory Program ` ~ v
- ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION
C V
- (c=Compliance OPERATION
V=Violation COMMENTS
~/
L~ ^ APPROPRIATE PERMIT ON HAND
^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE
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^ VISIBLE ADDRESS
^ CORRECT OCCUPANCY
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^ ' VERIFICATION OF INVENTORY MATERIALS
^ VERIFICATION OF QUANTITIES
~ ^ VERIFICATION OF LOCATION
^ PROPER SEGREGATION OF MATERIAL
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^
VERIFICATION OF MSDS AVAILABILITY /~
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H ^ 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
ANY HAZARDOUS WASTE ON SITE? ^ YES ~O
EXPLAIN:
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979
Inspector (Please Print) Fire Prevention / 1~` In /Shift of Site/Station #
White -Prevention Services - Yellow- Station-Copy Pink -Business Copy ~ - FD 2155 (Rev. 09/05
+ BUSBY AIR CONDITIONING & HEATING ____________________ SiteID: 015-021-000074 +
Manager
Location: 1111 ALTA VISTA DR
City BAKERSFIELD
CommCode: BFD STA 02
EPA Numb:
BusPhone: (661) 872-9025
Map 103 CommHaz High
Grid: 29A FacUnits: 1 AOV:
SIC Code:
DunnBrad:10-304-4756
Emergency Contact / Title Emergency Contact / Title
JAY BUSBY / OWNiER MIKE SMITH / PARTNER
Business Phone: (661) 872.-9025x Business Phone: (661) 872-9025x
24-Hour Phone ( ) - x 24-Hour Phone (661) 587-5800x
Pager Phone ( ) - x Pager Phone ( ) - x
Hazmat Hazards: Fire Press ImmHlth DelHlth
Contact Phone: (661) 872-9025x
MailAddr: 2714 SILVER DR State: CA
City BAKERSFIELD Zip 93306
Owner JAY W BUSBY Phone: (661) 871-9025x
Address 2714 SILVER DR State: CA
City BAKERSFIELD Zip 93306
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
Emergency Directives:
PROG A - HAZMAT
~~T'~ ~~ ~ ~: 5 X006
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.
~g r Date ~
-1- 02/28/2006
UNIFIED PROGRAM INSPECTION CHECKLIST
__ _ - - - ___ ._______.___._.-- _.d..~.....~,....~,,.,..,,. .~.,_,.~,
SECTION 1 Business .Plan and Inventory Program
•
'.ADDRESS
_ _/ lIl --~~~ _..I~~s~__.-..------ ------------------------. ___ _ __ ----- --- ..- -- -_ .._-._
PACILITYCONTACT
Bakersfield Fire Dept.
Environmental Services
- 900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
Tel: (661) 326-.3979
INSPECTION GATE INSPECTION TIME
PHONE No. No. oft-mployees
S~ L~96~ ~
Business ID Number
~ s-o2 l - oooa ~ y
Secrion 1: Business Plan and Inventory Pn~gram
Routine O Combined O Joint Agency OMulti-Agency O Complaint O Re-inspection
•
^. FIRE PROTECTION ~ ~- // ~~
-- - ...__----------- - ~~f..~- -G~"-
_ _.. ---- -~- O ..... - - - - - - - ... -- - -_.___._..
t~O SITE DIAGRAM ADEQUATE 8 ON HAND
ANY HAZARDOUS WASTE ON SITE?: ^ YES ~TIO
EXPLAIN:
QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT ~66~ ~ 326-3979
Inspector (Please Print) Fire Prevention 1st-In/Shik of Site
White -Environmental Services Velbw - Statbn Copy
~ _
Busi ess Site Responsi le P (Please Print) ~
Pink • Business Copy