HomeMy WebLinkAboutBUSINESS PLAN (2)
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BUSINESS OWNER/OPERATOR IDENTIFICATION -
KERA C:Ol1\TY ENVIROVMENTAL HEALTH SERVICES DEPARTMENT
2700 ~t STREET, SUITE 300 Unified Program Consolidated Form (UPCF)
BAKERSFIELD, CA 93301 FACILITY INFORMATION
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^ NEIL' BUSINESS (] Ol1T OF BUSINESS ®REVISE/UPDATE (EFFECT[VE 02 / ] 4 / 06 ) Paget of~
I. IDENTIFICATION
FACILITY ID# I BEGINNING DATE 100 ENDING DATE 101
~ - 02/14/06 02/14/07
BUSINESS NAME (Same as FACILITY M1AML• or D()A -Doing business As( 3 BUSINESS PHONE 101
Walgreens#3294 661-871-3035
BUSINL'SS Sll'E ADDRESS 103
2628 Mount Vernon Avenue
CITY 1oa
C`4 ZIP CODE los
Bakersfield 93306
DUN & BRADSTKEE"f 106 SIC CODE (4 digit #) 1°7
93-103-6651 5912, 7384
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C'OLRvTY ~~ I k~ ~~ l~l ~ ~~~f~ log
Kern Count
Bli51NFSS OPERATOR NAME 1°9 BUSINESS OPERATOR PHONE no
Walgreens Corporation 847-914-3853
II. BUSINESS OWNER.
UWNFR NAME 111 OWNER PHONE (tz
Walgreens Corporation 847-914-3853
OWNER MAILING ADDRESS 113
200 Wilmot Road
CITI' ~ 114 STATE Its ZIP CODE 116
Deerfield IL 60015
III. ENVIRONMENTAL CONTACT
CONTACT NAME ~~• ~,~1~•an[G 117 CONTACT PfiONE Ilg
Christina Chiappetta, Safety & C 1 Supervisor, MS 2171 847-914-3195
C"ONTAC'f MAILING ADDRESS 119
200 Wilmot Road
CITY 120 STATE 121 7_IP CODE 122
Deerfield IL 60015
-PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY-
] NAML 123 NAME 1'-g
(Dave Marcus gnes Macapagal
I~ITL[ I-'4 TITLE 129
'Store Manager istrict Photo Supervisor
BUSINESS PHONE 125 BUSINESS PHONE 130
.661-871-3035 559-307-7100 ~
24-I IOl1R PHONI 126 24-HOUR PHONE 131
661-587-3526 559-307-7100 ~
PAGER # 1'_-~ PAGER # lr_
!N/A /A
ADDI~f10NAl. LOCALLY COLLECTED INFORMATION: IJ3
APN: 0 0 5. 3 4 4. 3 9_ 0 4. 7
Environmental Contact E-Mail Address: Christina.chiappetta@walgTeens.com
C~crti(ication: Bascd nn my inquiry of those individuals responsible fur obtaining the information, I certily under penalty of law that f have personally examined and
am familiar with the infi~rmation submitted and ve the information is true, accurate, and complete.
S(G\ATURFOFOWNf:RiOPERATORORUESI N F REPRESENT (VF. DATE 134 NAME OFpOCUMENTPREPARER 135
7~31wV Alison Millard, Agent for Walgreens Corporatior_ `~
I NAME OI' SIGNER (prim( I3G
I TITLE OF SIGNER 13 `~
Dean Jarrett Divisional Merchandise Manager
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
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FACILITYCUNTACT
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Section 1: Business Plan and Inventory Program
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BUSINESS PLAN CONTACT INFORMATION ACCURATE 2003
^ VISIBLE ADDRESS
^ CORRECT OCCUPANCY
^ VERIFICATION OF INVENTORY MATERIALS
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- VERIFICATION OF QUANTITIES
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VERIFICATION OF LOCATION -
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^ PROPER SEGREGATION OF MATERIAL
^ VERIFICATION OF MSDS AVAILABILITYE
^ VERIFICATION OF FIAT MAT TRAINING
^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
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ANY HAZARDOUS WASTE ON SITE: ^ YES ~ O
UNIFIED PROGRAM INSPECTION CHECKLIST
SECTION 1 Business .Plan and Inventory Program
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Bakersfield Fire Dept.
Environmental Services
900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
' Tel: (661) 326-3979 __ _
FACILITY NAME INSPECTION DATE INSPECTION TIME
ADDRESS PHONE No. No. of Employees
FACILITVCONTACT Business ID Number
t s-o21- tai 910
Section 1: Business Plan and Inventory Pn~gram
^ Routine Combined O Joint Agency ^MultI-Agency ^ Complaint ^ Re-inspection
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ANY HAZARDOUS WASTE~OnN,,SITE~: tllYES ^ IVO
EXPLAIN: __ ' P o *;T!VN' ~ fi ` i.~ ~'['F
QUESTIONS REGARDING THIS 1NSPECTtON~ PLEASE CALL US AT ~GG'I ~ 326-3978
Inspector ase Print) Fire Prevention 1st-IMShift of Site
WAite - Envvonmenul Services Yelknv -Staten Copy
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Business Site Responsible Party (Please Printj
Pink -Business Copy
Bakersfield Fire Dept.
UNIFIED PROGRAM INSPECTION CHECKLIST 'Environmental Services
~'~'" 900 Truxtun Ave., Suite 210
SECTION 1 Business .Plan and Inventory Program Bakersfield, CA 93301
Tel: (661) 326-3979
FACILITY NAME WSPECTION DATE INSPECTION TIME
ADDRESS PHONE No. No. of Employees
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FACILITYCONTACT Business ID Number
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Section 1: Business Plan and Inventory Program /i5~ ~-b I
Routine ^ Combined ^ Joint Agency ^Mnlti-Agency O Complaint ^ Re-inspection
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ANY HAZARDOUS WASTE ON 517E?: YES I~NO
EXPLAIN:
~, QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT ~BG'I~ 326-3979
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Inspector (Ple Print) Fire Prevention 1st-InlShik of Site
White -Environmental Services velknv -Station Copy
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Business Site Re ible Party (Please Print)
Pink -Business Copy