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HomeMy WebLinkAboutBUSINESS PLAN,SAN JOAQUIN CARE CENTER 1611 HEIGHT STREET P.. ~ , SAN JOAQUINCARE CENTER EAST Manager ~/ve ~. ~~ ~~ Location: 1611 HEIGHT ST E City BAKERSFIELD CommCode: BFD STA 08 EPA Numb: SiteID: 015-021-000452 BusPhone: (661) 872-2324 Map 103 CommHaz Low Grid: 21B FacUnits: 1 AOV: SIC Code:8051 DunnBrad:77-026-7593 Emergency Contact / Title Emergency Contact / Title JOEL BOLTEN / ADMINISTRATOR DOTTS LACAP / DIR OF NURSES Business Phone: ,(661) 872-2324x Business Phone: (661) 872-2324x 24-Hour Phone (858) 405-5686x- 24-Hour Phone (858) 722-4352x Pager Phone (661) 496-2829x ~ Pager Phone ( ) - x 1 Hazmat Hazards: Fire Press ImmHlth Contact beh ~ e Phone: (661) 872-2324x MailAddr: 1611 HEIGHT ST E ~ State: CA City BAKERSFIELD Zip 93305 Owner PLEASANT CARE CORP Phone: (818) 248-9808 Address 2258 FOOTHILL BLVD State: CA City LA CANADA Zip 91101 Period Preparers Certif ' d: ParcelNo: to TotalASTs: _ TotalUSTs: _ RSs: No Gal Gal Emergency Directives: PROG A - HAZMAT ~i8 ~aa ~~~8 "(~~~5 ~ e ~ ~ ~ 2 I ~r~ ~~0-~~8 13asUd on nay inquiry of those individuals res~ensible 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. Sigi nature ~ Date -1- 02/06/2007 I1 '1 ~ SAN JOAQUIN CARE CENTER EAST SiteID: 015-021-000452 3 ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F P IH G 1686.00 FT3 Low -2- 02/06/2007 -3- 02/06/2007 F SAN JOAQUIN CARE CENTER EAST SiteID: 015-021-000452 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: CTR HALL CAS# 7782-44-7 STATE T TYPE PRESSURE -~- TEMPERATURE ~~ CONTAINER TYPE ~ ~GaS I Pure Above Ambient I AmhiPnt I Pc~RT _ PRF~G rvT.TNnF.R I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1686.00 FT3 1686.00 FT3 1686.00 FT3 - AZARDOUS COMPONENTS °aWt. RS CAS# 100.00 Oxygen, Compressed No H 7782447 Ilri4ti1C1J t] J JL' ~J.71~1LS1V 1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -4- 02/06/2007 F SAN JOAQUIN CARE CENTER EAST SiteID: 015-021-000452 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 01/31/2000 ~ CALL 911. Employee Notif./Evacuation 08/13/1990 CALL-911. Public Notif./Evacuation 06/26/2006 CALL 911, ~A RADOJKOVICH 858-405-5686 OR DOTTS LACAP 858-722-4352. ~7oe l X30 ~ ~,J 8/ ~ y~o2a 9978 Te~s-i e ~3~ c z ~ ~l ~ 6 ~a 7o d ~ Emergency Medical Plan BAKERSFIELD MEMORIAL HOSPITAL, 420 34TH ST, 327-1792. 06/26/2006 -5- 02/06/2007 F SAN JOAQUIN CARE CENTER EAST SiteID: 015-021-000452 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 08/13/1990 ~ OXYGEN CYLINDER CHAINED WITH PROPER FITTINGS. Release Containment RELEASE OXYGEN RID VENT TO ATMOSPHERE. 01/31/2000 Clean Up RETURN TANKS TO CHAINED STORAGE. 01/31/2000 Vl.ilCi 1CC.7"VULC.:C HUl.1Vdl.lUil -6- 02/06/2007 F SAN JOAQUIN CARE CENTER EAST SiteID: 015-021-000452 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ a,~ec;icdl nd'GCilu~ Utility Shut-Offs A) GAS - BEH KITCHEN NEAR JANITORS CLOSET B) ELECTRICAL - INSIDE KITCHEN STORAGE W OF BLDG W/EMER GEN C) WATER - FRONT OF BLDG BY ENTR D) SPECIAL - NONE E) LOCK BOX - NO 01/17/2007 Fire Protec./Avail. Water 01/17/2007 PRIVATE FIRE PROTECTION - SPRINKLERS, FIRE EXTINGUISHERS, AND AUDIBLE FIRE ALARM SYSTEM. FIRE HYDRANT - ACROSS ST FROM 1601 HEIGHT ST. Building Occupancy Level 06/26/2006 103 EMPLOYEES -7- 02/06/2007 F SAN JOAQUIN CARE CENTER EAST SiteID: 015-021-000452 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 06/05/2006 ~ MATERIAL SAFETY DATA SHEETS AVAILABLE. BRIEF SUP~II~lARY OF TRAINING PROGRAM: TWO ANNUAL DISASTER DRILLS, QUARTERLY FIRE DRILLS, MONTHLY EMERGENCY GENERATOR ACTIVATIONS. INSERVICE TRAINING ON OXYGEN USE. INSPECTIONS OF OXYGEN EQUIPMENT BY CONTRACTED SERVICE. ACTUAL FIRE EXTINGUISHER TRAINING ANNUALLY. rcxyC ~ Held for Future Use riciu Lvi r u~.uic roc -8- 02/06/2007 5.i - .1 'r ~~ SAN JOAQUIN CARE CENTER WEST Manager JO~~ ~L~~ , Location: 1611 HEIGHT ST W City BAKERSFIELD CommCode: BFD STA 08 EPA Numb: SiteID: 015-021-000451 BusPhone: (661) 872-2324 Map 103 CommHaz Low Grid: 21B FacUnits: 1 AOV: SIC Code:8051 DunnBrad:77-026-7593 Emergency Contact / Title Emergency Contact / Title JOEL BOLTEN / ADMINISTRATOR / DIR OF NURSES Business Phone: (661) 872-2324x Business Phone: (661) 872-2324x 24-Hour Phone (858) 405-5686x 24-Hour Phone (858) 722-4352x Pager Phone (661) 496-2829x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact oel o~ e Phone: (661) 872-2324x MailAddr: 1611 HEIGHT ST W State: CA City BAKERSFIELD Zip 93305 Owner PLEASANT CARE CORP Phone: (818) 248-9808 Address 2258 FOOTHILL BLVD State: CA City LA CANADA Zip 91101 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT 8 ~ ~~ 8 5aa 9 9 ~ ~ ~ a 700 8 l T s~ie ~3iez~~ als id i ~~~7 u v ^ed or' my inquiry of those ind b:atning the information, I certify r f a or >~p4rl~iblE' n;ier penalty pf low that i have personaity Yamined and am familiar with the information ubmittfd and believe the information is true, ccurate, and complete. ' . oa-~~- ~o ~ ~ ~°""'"° Date ign~ tore -1- 02/06/2007 ~~ , F SAN JOAQUIN CARE CENTER WEST SiteID: 015-021-000451 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F P IH G 2810.00 FT3 Low -2- 02f06/2007 -3- 02/06/2007 ., F SAN JOAQUIN CARE CENTER WEST SitelD: 015-021-000451 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: CTR HALL OPPOSITE 114 CAS# 7782-44-7 STATE T TYPE PRESSURE ~~ TEMPERATURE ~~ CONTAINER TYPE ~GaS I Pure Above Ambient I Ambient I FIXED PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Co224100rFT3 Daily2810100m FT3 I Daily2248r00e FT3 tita~r~tcLUUS ~uinr~iv~lv~t~~ %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 tiHGHt'C1J E~ ~St;JJ1~1L'1V-1-5 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low -4- 02/06/2007 F 5AN JOAQUIN CARE CENTER WEST SiteID: 015-021-000451 ~ Fast Format ~ ~ Notif.JEvacuation/Medical Overall Site ~ ~ Agency Notification 01/31/2000 ~ CALL 911. Employee Notif./Evacuation 01/31/2000 CALL 911. Public Notif.jEvacuation 06/26/2006 CALL 911, CALL YUBA RADOJKOVICH 85$-405-5686 OR DOTTS LACAP 858-722-4352. .~el ,~ L/e~- X18 ~~~a q97~ Te~sS/e ~3ic zr ~'/k' (~~d 76oS Emergency Medical Plan 06/26/2006 BAKERSFIELD MEMORIAL HOSPITAL, 420 34TH ST, 327-1792. -5- 02/06/2007 F SAN JOAQUIN CARE CENTER WEST SiteID: 015-021-000451 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 11/06/1990 ~ TANKS ARE CHAINED TO WALL AND USE PROPER FITTINGS. Release Containment RELEASE OXYGEN RID VENT TO ATMOSPHERE. 01/31/2000 Clean Up RETURN TANKS TO CHAINED STORAGE. 01/31/2000 V L11C1 1CC w7V U1LC PiU l.1 VCL 1.1 V11 -6- 02/06/2007 F SAN JOAQUIN CARE CENTER WEST SiteID: 015-021-000451 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ aNv~:.~cal na~ai.u5 Utility Shut-Offs 06/05/2006 A) GAS - BEH KITCHEN BY TRASH BINS B) ELECTRICAL - FOOD STORAGE RM C) WATER - FRONT OF BLDG ON SIDEWALK D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 01/17/2007 PRIVATE FIRE PROTECTION - SPRINKLERS, FIRE EXTINGUISHERS, AND AUDIBLE FIRE ALARM SYSTEM. FIRE HYDRANT - ACROSS ST FROM BLDG. Building Occupancy Level 06/26/2006 103 EMPLOYEES -7- 02/06/2007 1, 'v, , ._ F SAN JOAQUIN CARE CENTER WEST SitelD: 015-021-000451 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 06/26/2006 ~ MATERIAL SAFETY DATA SHEETS AVAILABLE. BRIEF SUMMARY OF TRAINING PROGRAM: TWO ANNUAL DISASTER DRILLS, QUARTERLY FIRE DRILLS, MONTHLY EMERGENCY GENERATOR ACTIVATIONS. IN-SERVICE TRAINING ON OXYGEN USE. INSPECTIONS OF OXYGEN EQUIPMENT BY CONTRACTED SERVICE. rc~y~ L nciu ivi r u~.utc vac nclu tai rut.uic ~5C -8- 02/06/2007 SAN JOAQUIN CARE CENTER WEST SiteID: 015-021-000451 = Manager BusPhone: (661) 872-0705 Location: 1611 HEIGHT ST W Map 103 CommHaz Low City BAKERSFIELD Grid: 21B FacUnits: 1 AOV: CommCode: BFD STA 08 SIC Code:8051 ~~ EPA Numb: ~ DunnBrad:77-026-7593 ~j 5 - _ c1~'iZ ,n ~ i Emergency Contact / 'tle Emergency Contact / Title / ADMINISTRATOR JESS CRUZATE / DIRECTOR OF NRS Business Phone: (661) 872-2324x Business Phone: (661) 872-2324x 24-Hour Phone (661) 872-2324x 24-Hour Phone (661) 633-6502x er,- Phone ( 818 ) -E~~~ Z Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact Phone: (661) 872-0705x MailAddr: 1611 HEIGHT ST W State: CA City BAKERSFIELD Zip ~: 93305 Owner PLEASANT CARE CORP Phone: (818) 248-9808x Address 2258 FOOTHILL BLVD State: CA City LA CANADA Zip 91101 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ Hazmat Inventory = ~ Alphabetical Order One Unified List ~ All Materials at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN ~ F P IH G 2810.00 FT3 „Low ~ o X006 rh~,2 7~ (~ - SPG~~~ S~(ST~, -1- 03/31/2005 y SAN JOAQUIN CARE CENTER EAST Manager Location: 1611 HEIGHT ST E City BAKERSFIELD ~~~ ~~~~- CommCode: BFD STA 08 ~ EPA Numb: ~' SiteID: 015-021-000452 BusPhone: (661) 872-0705 Map 103 CommHaz Low Grid: 21B FaCUnits: 1 AOV: SIC Code:8051 /C ~~,/~ DunnBrad:77-026-7593 t~ Emergency Cont ~ itle Emergency Contact / Title ziysrw~'yn~°a"-i ~1aaa / ADMINISTRATOR JESS CRUZATE / MAINTENANCE SUP Business Phone: (661) 872-2324x Business Phone: (661) 872-2324x 24-Hour Phone (661) °~~ 'd'" ~ 24-Hour Phone (661) 633-6502x Phone ( 81 -_ t~~~_~8' ~. Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact Phone: (661) 872-0705x MailAddr: 1611 HEIGHT ST E State: CA City BAKERSFIELD Zip 93305 Owner PLEASANT CARE CORP Phone: (818) 248-9808x Address 2258 FOOTHILL BLVD State: CA City LA CANADA Zip 91101 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: ~ Hazmat Inventory One Unified List ~ ~ Alphabetical Order All Materials at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN ~/) , F P IH G 1686.00 FT3 Low ~~ ENT'D OC T 2 0 2006 -1- 03/31/2005 ~- + SAN JOAQUIN CARE CENTER EAST ________________________ SiteID: 015-021-000452 + Manager Location: 1611 HEIGHT ST E City BAKERSFIELD BusPhone: (661) 872-2324 Map 103 CommHaz Low Grid: 21B FacUnits: 1 AOV: 1 w SIC Code:8051 I CommCode: BFD STA 08 ~ ~ _ _ EPA Numb: ~A ~~O ~K.~vl G DunnBrad:77-026-7593 ------------------ ---------------- ---- --------- Emergency Conta / Title Emergency Contact / Title - / ADMINISTRATOR DOTTS LACAP / DIR OF NURSES Business Phone: (661) 872-2324x Business Phone: (661) 872-2324x 2 4 -Hour Phone ~(~-6.9-;-~93 4~~~ 2 4 -Hour Phone ( 8 5 8) 7 2 2- 4 3 5 2 x Pager Phone --~~ A ~;--t ~8 - ~ ~.].x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact Phone: (661) 872-2324x MailAddr: 1611 HEIGHT ST E State: CA City BAKERSFIELD Zip 93305 Owner PLEASANT CARE CORP Phone: (818) 248-9808x Address 2258 FOOTHILL BLVD State: CA city LA ~- C~rvR~~ zip 91101 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT s~s~-4c~5-5b~~ 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. \~~'"',~' 1 ~ -~l ~ O gnature Date FNrp JU. N 26 2D0 6 -1- 06/05/2006 i ~. + SAN JOAQUIN CARE CENTER WEST ________________________ SiteID: 015-021-000451 + Manager Location: 1611 HEIGHT ST W City BAKERSFIELD I CommCode: BFD STA 08 EPA Numb: BusPhone: (661) 872-2324 Map 103 CommHaz Low Grid: 21B FacUnits: 1 AOV: ~ yt-t~~+..~Q-4~0~'k-owtL~ SIC Code:8051 1 DunnBrad:77-026-7593 _____________________________________________________ Emergency Contact / Title Emergency Contact / Title / ADMINISTRATOR DOTTS LACAP / DIR OF NURSES Business Phone: (661) 872-2324x Business Phone: (661) 872-2324x ~n~_ga, _aQl,~+ 24-Hour Phone (858) 722-4352x 24-Hour Phone (- s~o=~ Pager Phone -(~~;-5-.~-?~~~~e Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact Phone: (661) 872-2324x MailAddr: 1611 HEIGHT ST W State: CA City BAKERSFIELD Zip 93305 Owner PLEASANT CARE CORP Phone: (818) 248-9808x Address 2258 FOOTHILL BLVD State: CA City :.-LA CANADA Zip 91101 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: U ~ PROG A - HAZMAT ~S~' - Lf o S- ~ G ~ E ENS ~uN 2s 2 006 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. ~-"1-0.6 ignature Date t=====_________________________________________________________________________+ -1- 06/05/2006 UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business .Plan and Inventory Program • Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 ' Tel: (661) 326-3979 FACILITY NAME ADDRESS FACILITYCONTACT o~ X72 ~ 0.7o S_ isiness ID Number IS-021- OQp~j-,SZ Section 1: Business Plan and Inventory Program ^ Routine Combined ^ Joint Agency ^Mnlti-Agency ^ Complaint ^ Re-inspection l~ ~ u C V pl nce) OPERATION ( COMMENTS on V=vo a ~ / I!d ^ APPROPRIATE PERMIT ON HAND ^ D BUSINESS PLAN CONTACT INFORMATION ACCURATE 1 L~J ^ VISIBLE ADDRESS Cl ^ CORRECT OCCUPANCY ^ ~ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES IJd ^ .VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL d ^ VERIFICATION OF MSDS AVAILABILITYE ----- -- - ^ -- - ---- ---- - -- ------_ - _ _........ _ ... -- - -..__._ ..._.__ VERIFICATION OF HAT MAT TRAINING f ._.. __ _ - - .... __ ._.. ....... _ _ . "~ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ~ fd ^ CONTAINERS PROPERLY LABELED --1- tJ -. ^ _ - -- - --__ . _. __ .._... _ .. _._.~ HOUSEKEEPING _. . _ _ _ ' •~ ^. FIRE PROTECTION ...._. _ ._..._ ... - --... -- ~ ^ ^ SITE DIAGRAM ADEQUATE ~ ON HAND ANY HAZARDOUS WASTE ON SITE?: ^ YES ^ NO EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT ~G6') ~ 3Z6-3979 Inspector (Please Print) Fire Prevention 1st-InIShiR of Site WhHe -Environmental Services Yellow -Stefan Copy Business Site Responsible Party (Please Print) Pink • Business Copy 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 ACIUT'/ NAME i /j ADDRESS FACIIITYCONTACT ~ ,// - -~ ~- / _~ ~--__--~_~~--~ -~-.~-~_ 6 ~~ ~ ~( r- 15-021- d'~a~S!,~'-~;,, Section 1: Business Plan and Inventory Program ^ Routine ^ Combined ^ Joint Agency ^Mu1ti-Agency O Complaint ^ Re-inspection C V \V=Vioatolnncel OPERATION ) COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS DEC 4 2003 ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ~ ^ VERIFICATION OP LOCATION h/~--~ ~ LC ~ Z 9.~LU ' ^ ----- ~ PROPER SEGREGATION OF MATERIAL -- - - ------_..---- `__ __~_ ~,_ ----- - - °~ `~ ~ ~~00/ ~- oC~z d ^=~~5 ------------~---..---~-- ^ VERIFICATION OF MSDS AVAILABILITYE ^ VERIFICATION OF HAT MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES T ~ ~!/ ~ V - ^ EMERGENCY PROCEDURES ADEQUATE -_---` ~Q,~--~ ~Il/ /~ Q O ! ^ ~ CONTAINERS PROPERLY LABELED _- -- - -~-_ _- ` ^ HOUSEKEEPING ~'~IRE PROTECTION ~ ~L7c r'~~ ~ ~~~~~~~ ~ ^ SITE DIAGRAM ADEQUATE ~ ON HAND ANY HAZARDOUS WASTE ON SITE: ^ YES ~NO EXPLAIN: (! ~ 6C~f S ~~ ri'`Z~ QU NG T INSPECTIONS PLEASE CALL US AT (881) 328-3979 -- - « ~L--~~ -----• Inspector - ~ Badge No White • Environmental Services Yellow • Station Copy Business Site Respons' le arty y~ Pink • Business Copy V UNIFIED PROGRAM INSPECTION CHECIi(LiST • SECTION 1 Business ,Plan and Inventory Program Bakersfield Fire Dept. ' Environmental Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 lel: (bbl) 3Lb-.Sy/y WSPECTION DATE INSPECTION TIME FACILITY NAME ADDRESS ~r ~r~(~ c PHONE No. No. of Empbyees FACILITYCONTACT 8usinese ID Number 15-021- C'~©a~S~ Section 1: Business Plan and Inventory Program Routine C~Combined O Joint Agency DMulti-Agency O Complaint O Re-inspection r1 U ANY HAZARDOUS WASTE ON SITE?: ^ YES ^ NO EXPLAIN: • QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT 661 326-3979 Ins ctor Please Print Fire Prevention tst-In/Shill of Site White -Environmental Servicea Yelkriv - Stetpn Copy Business ~t e _ nsibTe'PSTIp(PI'8ase ring ~ Pink • Business Copy UNIFIED PROGRAM INSPECTION CHECKLIST Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 SECTION 1 Business Plan and Inventory Program • FACILITY NAME ECTIO N DATE INSP INSP ION TIME E CT p 9 11L.-~Y---J~- - / 7~ ~~ --- "--- ---------- PHONE No. No. of Employees g~Z-o~ 0.~ ~~~-- !0 2 ~~-~-~~-~_--~-~~-~- Business ID Number 15-021 - C~pp~~-5'I Section 1: Business Plan and Inventory Program Routine. ^ Combined ^ Joint Agency OMulti-Agency ^ Complaint ^ Re-inspection C V ~ V=V o atfonnce l OPERATION ^ APPROPRIATE PERMIT ON HAND ^ Q~ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY --- _ . ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITYE ^ VERIFICATION OF HAT MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE ~ ON HAND COMMENTS ANY HAZARDOUS WASTE ON SITE: EXPLAIN: ^ YES ~ No QUESTIONS REGARDING T S INSPECTION? PLEASE CALL US AT (GB'I~ 326-3979 k `r~/~ In or Badge No., siness Site Responsible Party White -Environmental Services Yellow - Statbn Copy Pink • Business Copy