HomeMy WebLinkAboutBUSINESS PLANu ~ -_
ii FAMILY PLNNG ASSOC.
`, 2500 H STREET
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UNIFIED PROGRAM INSPECTION CHECKLIST
SECTION 1: Business Plan and Inventory Program
Prevention Services
B FRS,: , , „ 900 Truxtun Ave., Suite 210
FIRE Bakersfield, CA 93301
ARTM Tel.: (661) 326-3979 i
Fax: (661) 872-2171
FACILITY NAME INSPECTION DATE ION TIME
INSPEC
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AD RESS 5.,.~ ~
~~ 1-~" PHO E N
3~3-6oZ3 NO OF EMPLOYEES
l5
FACILITY CONTACT
~/I BUSINESS ID NUMBER
15-021- !~
G~~ H f~, ~ ~
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SectEan 1: Business Plan and Inventory Program ~~~~, ~~;
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ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE- P C N
C V (C=Compliance OPERATION
V=Violation __
COMMENTS
®~^ APPROPRIATE PERMIT ON HAND
^ BUSIf1eSS PLAN CONTACT INFORMATION ACCURATE
L'9~ ^ VISIBLE ADDRESS
~ ^ CORRECT OCCUPANCY N~'D D E ~ ~ ~ z~~g
^ VERIFICATION OF INVENTORY MATERIALS
^ VERIFICATION OF QUANTITIES
^ VERIFICATION OF LOCATION
~, /
I/~ ^ PROPER SEGREGATION OF MATERIAL
^ VERIFICATION OF MSDS AVAILABILITY ~
J
^ VERIFICATION OF HAZ MAT TRAINING
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~
^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
~
/
td' ^ EMERGENCY PROCEDURES ADEQUATE
^ CONTAINERS PROPERLY LABELED
~~ HOUSEKEEPING
^ FIRE PROTECTION
^ SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITE?
EXPLAIN:
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979
;~ ~
Inspector (Please Print Fire Prevention / 1'~ In /Shift of Site/Station # usin ss Site /Responsible Party (Please Print)
^ YES ^ NO
White -Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05
+ FAMILY PLANNING ASSOC MED GRP _______________________ SiteID: 015-021-001036 +
Manager BusPhone: (661) 323-6023
Location: 2500 H ST Map 102 CommHaz High
City BAKERSFIELD Grid: 25B FacUnits: 1 AOV:
CommCode: BFD STA Ol SIC Code:8011
EPA Numb: DunnBrad:
Emergency Contact / Title Emergency Contact ,( Title
/i~larl(~ ~uYt:h ~j1ap-.c,C,a1 li5c~ Wlt~r( A~'~zS ~SS~- ~-c
Business Phone: (661) 323-6023x D Business Phone: (661) 323-6023x
24-Hour Phone (661) ~'^° """--3q~:.o~l1q 24-Hour Phone (661) •~`~~~=303 ~ ~3$
•~ag~ Phone ( 6 61) 3 ^~-~-= sT~ r Phone ( t, ~ a) q0(~ -3~,1,5~ x
Hazmat Hazards: Fire Press ImmHlth
Contact Phone: (661) 323-6023x
MailAddr: 2500 H ST State: CA
City BAKERSFIELD Zip 93301
Owner FAMILY PLANNING ASSOC MED GRP INC Phone: (562) 426-9661x
Address 3050 AIRPORT WY State: CA
City LONG BEACH Zip 90806
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
Emergency Directives : ~. ~)! ~'„ )
PROG A - HAZMAT ~~1 i I~r
~~
~~ ` / lam"
~ ~L~
~ ~ i~~
~~
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
sufjmitted and believe the information is true,
accurate, and complete.
P Date
~~ti
ENT'D ,1 ~J N 0 8 2006
~~ 1
-1- 05/30/2006
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
---~~~.LI t~ ~ to ~,~, L ~~ ac------------ - -------------------- ------- ---------- - -- - - ----- -- --11E
ADDRESS ` - ~ PHONE No. No. of Employee-~
z~
~~ 5
-~ s N - ---------------__ ------------- ---- -
FACILITYCONTACT Business ID Numbet
Section 1: Business Plan and Inventory Pn~gram j J°j
L~'~toutine ^ Combined ~ Joint Agency ^hulti-Agency ^ Complaint ^ Re-inspection
zoos
C V \V=Voatoinnce~ OPERATION COMMENTS
^ APPROPRIATE PERMIT ON HAND
,^ BUSINESS PLAN CONTACT INFORMATION ACCURATE
LCl" ^ VISIBLE ADDRESS
lJ ^ CORRECT OCCUPANCY I
III ^ VERIFICATION OF INVENTORY MATERIALS
l~ ^ VERIFICATION OF QUANTITIES
^ VERIFICATION OF LOCATION
(~ ^ PROPER SEGREGATION OF MATERIAL
I~ ^ VERIFICATION OF MSDS AVAILABILITYE
L7 ^ VERIFICATION OF HAT MAT TRAINING
^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
LK ^ EMERGENCY PROCEDURES ADEQUATE
--~-/ -- ---- - --- ---- ---- ---- --- --I- -- - - ----- - - _. - - _. __ . _ .. _ _. _..
NJ ^ CONTAINERS PROPERLY LABELED
^ HOUSEKEEPING
^ FIRE PROTECTION
L7 ^ SITE DIAGRAM ADEQUATE 8c ON HAND
ANY HAZARDOUS WASTE ON SITE: ^ YES ~O
EXPLAIN:
QUESTIONS REGA ING THIS INSPECTIONS PLEASE CALL US AT ~G6'I ~ 326-3979
Inspe Badge No.,
White -Environmental Services Veltow -Station Capy
Business Site Responsible Party /
Pink -Business Copy /