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HomeMy WebLinkAboutBUSINESS PLAN (2)-- '\ ~_ / ~~ r ~~ `` i 1`M ~~; MAACO ~i~' 43'L1 STINE RD ~~ ~T~ j~j~oC7 ~, ~~~ ~~~~ ~~> UNIFIED PROGRAM INSPECTION CHECKLIST ~~~ ~ Prevention Services B e R s ,: , 0 900 Truxtun Ave., Suite 210 FARE Bakersfield, CA 93301 SECTION 1: Business Plan and'Inventory Program ° arrr~ TeY.: '(661) 326-3979 Fax: (661) 872-2171 FACILITY NAME _ INSPECTI N DATE INSPECTION TIME c~ . ~ ~ ~ /a v ~ ~ /~ 3a ADDRESS ~ ~ - E . PH NO OF E PLOYEES _ J ~ ~ ` ~~~~ ~ 3 ~ FACILITY CONTACT BUSINESS ID NUMBER C OtQ.)'v 15-021- OD~DSa ,-- i .Section 1: Business Planand pnventory Program ~~. ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V ~ C=Compliance OPERATION V=Violation - COMMENTS ^ APPROPRIATE PERMIT ON HAND ^ BUSIIIeSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ~19 1 Q ~ ~ ~ ;' [ I .I ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ' ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES I'~ ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED - ^ HOUSEKEEPING ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND D ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~ '(~~l.J fs'Q2 13 ~r ~ ~, ~® Inspector (Please Print) Fire Prevention / 1°' In /Shift of Site/Station # B siness Sit /Responsible Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy - FD 2155 (Rev. 09/05 YES ^ NO /~J _ l' ~I .w 1- MAACO AUTO PAINTING SiteID: 015-021-002050 Manager DANNY CROWNOVER JR Location: 4321 STINE RD City BAKERSFIELD CommCode: BFD STA 13 EPA Numb: BusPhone: (661) 833-1253 Map 123 CommHaz High Grid: 14C FacUnits: 1 AOV: SIC Code:7532 DunnBrad: a~ Emergency Contact / Title Emergency Contact / Title BECKY OBS ORNE / OWNER DENVER OSBORNE / OWNER Business Phone: (661) 833- 1253x Business Phone: (661) 833-1253x 24-Hour Phone (661) 665- 2685x 24-Hour Phone (661) 665-2685x Pager Phone (661) 301- 0141x Pager Phone (661) 301-0141x Hazmat Hazards: Fire Press React ImmHlth DelHlth Contact HOWAIDA GIRGIS Phone: (661) 833-1253x MailAddr: 4321 STINE RD State: CA City BAKERSFIELD Zip 93313 Owner .GEORGE & HOWAIDA GIRGIS _ Phone: (661) ' ~ 833-1253x 3 ~ " Address ~~ e ~ y may 1-re,-~~,.,f State : CA ~ ~ ~~~ ~ City BAKERSFIELD Zip 9333: y33/y Period to TotalASTs: - Gal Preparers TotalUSTs: = Gal Certif ~d: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG S - SPRAY PAINT BOOTH ENT°D ,1 U ~ 2 3 ZOOS i3ased on my inquiry of those individuals respansi~ie for ob~a~nin;~ the information, I c:,~rtify under penaity of later that l have personally examined ar~d «m familiar ~~;ith the information sut~mitted an~~ beiiaue the information is true, accurate, and compiete. 7 ~ Signature / Date -1- 07/12/2007 s F MARCO AUTO PAINTING ~ Hazmat Inventory = ~ MCP+DailyMax Order = SiteID: 015-021-002050 ~ By Facility Unit ~ Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP ACETYLENE E F P IH G 300.00 FT3 Hi ACETONE F R IH L 20.00 GAL Mod OXYGEN F IH DH G 300.00 FT3 Low ACRYLIC POLYMER F IH L 60.00 GAL UnR WASTE PAINT F DH L 35.00 GAL UnR -2- 07/12/2007 -3- 07/12/2007 r '~ F MARCO AUTO PAINTING SiteID: 015-021-002050 ~ ~ Inventory Item 0004 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME ACETYLENE Days On Site 365 Location within this Facility Unit Map: Grid: SW CRNR CAS# 74-86-2 ~GasATE TYPE T PRESSURE TEMPERATURE CONTAINER TYPE TPure I Above Ambient Ambient PORT. PRESS. CYLINDE~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 300.00 FT3 300.00 FT3 300.00 FT3 HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Acetylene Yes 74862 ritiGEitCL H.7 A~~~1~1tS1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME ACETONE Days On Site 365 Location within this Facility Unit Map: Grid: CAS# Liquid TPureE ~ Ambient~E ~ A~PeRATURE DRUM/BARRELEMETALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 20.00 GAL 20.00 GAL azr~c~rucLVU~ ~.vi•trvi~r,l~tS oWt. RS CAS# 100.00 Acetone No 67641 nr-ic~rutL ti. 7i7r,.7J1"1L~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F R IH / / / Mod -4- 07/12/2007 T ~ F MAACO AUTO PAINTING SiteID: 015-021-002050 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: SW CRNR CAS# 7782-44-7 STATE T TYPE T PRESSURE ~ TEMPERATURE ~ CONTAINER TYPE ~GaS I Pure I Above Ambient I Ambient I PORT _ PRR~S _ C"YT,TNI~F.R I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 300.00 FT3 300.00 FT3 300.00 FT3 HAZARDOUS COMPONENTS %Wt• RS CAS# 100.00 Oxygen, Compressed No 7782447 i1HGL•i.RL HJ r7 L~iJ ~J 1•ll..,1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME ACRYLIC POLYMER Days On Site 365 Location within this Facility Unit Map: Grid: CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~ Ambient ~ Ambient DRUM/BARREL-METALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 60.00 GAL 60.00 GAL HAZARDOUS COMPONENTS %Wt. RSA CAS# HAZARD AS SESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / UnR -5- 07/12/2007 r F MAACO AUTO PAINTING ~ Inventory Item 0005 COMMON NAME / CHEMICAL NAME WASTE PAINT Location within this Facility Unit STATE Liquid TYPE PRESSURE Waste ~ Ambient SiteID: 015-021-002050 ~ I Facility Unit: Fixed Containers at Site ~ Days On Site i 365 Map: Grid: CAS# TEMPERATURE CONTAINER TYPE Ambient DRUM/BARREL-METALLI~ AMOUNTS AT THIS LOCATION Daily Average 35.00 GAL Largest Container Daily Maximum 35.00 GAL 35.00 GAL HAZARDOUS COMPONENTS oWt. RS CAS# titj~HtcL Ha~~aari~iv~l~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / UnR -6- 07/12/2007 F MARCO AUTO PAINTING SiteID: 015-021-002050 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 10/18/2000 ~ I CHECK PAINT ROOM EVERYDAY. Employee Notif./Evacuation 10/18/2000 IF ANY RELEASE CALL 911. Public Notif./Evacuation 10/18/2000 EMPLOYEES ARE TRIANED TO EXIT LOCATION AND CALL 911 IN THE EVENT OF AN EMERGENCY. Emergency Medical Plan DR CHANDRASEKARAN 327-5401 OR DR EMANUEL DOZIER 859-2211. 10/18/2000 -7- 07/12/2007 F MAACO AUTO PAINTING SitelD: 015-021-002050 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 10/18/2000 ~ MONTHLY SAFETY MEETINGS. Release Containment 10/18/2000 EVACUATE LOCATION AND CALL 911. Clean Up 06/01/2006 IF SPILL OR RELEASE IS BEYOND OUR MEANS, WILL CALL LOCAL CONTRACTOR TO PROPERLY MITIGATE AND DISPOSE OF. V1.11C 1. 1CC.7-V ILl C:C Hl: l.lVdl~1V11 -8- 07/12/2007 F MARCO AUTO PAINTING SiteID: 015-021-002050 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ J~1C l.:Ld1 IldGdLU~ Utility Shut-Offs 02/21/2007 NEAR COMPRESSORS IN BACK OF SHOP Fire Protec./Avail. Water 02/21/2007 SEVEN FIRE EXTINGUISHERS AND SPRINKLERS. Building Occupancy Level 03/14/2006 12 EMPLOYEES -9- 07/12/2007 F MAACO AUTO PAINTING SiteID: 015-021-002050 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 06/01/2006 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: VIDEO AND MONTHLY TRAINING SESSIONS. rayc c. nclu 1Vt 1'Ul.U1.C UDC L1C1U LVl. I'U1.1110 U.5'e -10- 07/12/2007 .~- ~: -' MAACO AUTO PAINTING T SiteID: 015-021-002050 Manager ~n~~ Cr'or,~n~h~-i y1'P• BusPhone: (661) 833-1253 Location: 4321 TINE RD Map 123 CommHaz High City BAKERSFIELD Grid: 14C FacUnits: 1 AOV: CommCode: BFD STA 13 EPA Numb: SIC Code:7532 DunnBrad: Emergency Contact / Title Emergency Contact / Title BECKY OBS ORNE / OWNER DENVER OSBORNE / OWNER Business Phone: (661) 833-1253x Business Phone: (661) 833-1253x 24-Hour Phone (661) 665-2685x 24-Hour Phone (661) 665-2685x Pager Phone (661) 301-0141x Pager Phone (661) 301-0141x Hazmat Hazards: ~ Fire Press React. ImmHlth DelHlth Contact HOWAIDA GIRGIS Phone: (661) 833-1253x MailAddr: 4321 STINE RD State: CA City BAKERSFIELD Zip 93313 Owner GEORGE & HOWAIDA GIRGIS Phone: (661) 833-1253x Address 10603 FINCHLEY DR State: CA City BAKERSFIELD Zip 93311 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG S - SPRAY PAINT BOOTH Dried on my inquiry of thoe individuai;5 responsible for obtaining the information, I certify ~N'r'D 1- under penalty of law that I have personally 1" EB 2 1 2007 examined and am familiar with the information submitted and believe the information is true, accurate, and complete. Signature Date -1- 02/02/2007 n F MARCO AUTO PAINTING SiteID: 015-021-002050 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP ACETYLENE E F P IH G 300.00 FT3 Hi ACETONE F R IH L 20.00 GAL Mod OXYGEN F IH DH G 300.00 FT3 Low ACRYLIC POLYMER F IH L 60.00 GAL UnR WASTE PAINT F DH L 35.00 GAL UnR -2- 02/02/2007 -3- 02/02/2007 u i F MAACO AUTO PAINTING ~ Inventory Item 0004 COMMON NAME / CHEMICAL NAME ACETYLENE Location within this Facility Unit SW CRNR STATE TYPE PRESSURE _ Gas TPure ~-Above Ambient SiteID: 015-021-002050 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 74-86-2 TEMPERATURE CONTAINER TYPE Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I ,Daily Average 300.00 FT3 300.00 FT3 300.00 FT3 tit~~xru~VU~ wlnrVlv~lvl~ %Wt. RS CAS# 100.00 Acetylene Yes 74862 tiHGL1KIJ 1~~ ~Ir~51~1L'1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Hi ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME ACETONE Location within this Facility Unit Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# Liquid TPureE ~ AmbRient~E ~ AmbientT~E DRUM/BARRELEMETALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 5.00 GAL 20.00 GAL 20.00 GAL IlEiGL~t'CLV U ~7 1=V1"lYV1VL' 1V 1.7 %Wt. RS CAS# 100.00 Acetone No 67641 riHGKtCL 1-1.7 .7~~~1~1L"1V1a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F R IH / / / Mod -4- 02/02/2007 r, F MAACO AUTO PAINTING SiteID: 015-021-002050 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: SW CRNR CAS# 7782-44-7 ~GaSATE ~ TYPE ~AboveSAmbEent TEMPERATURE CONTAINER TYPE Pure ~ Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATIONI Largest Co300100rFT3 .Daily 300100m FT3 1 Daily 300r00e FT3 tir~~titcL~uS ~~l~iruiv~iv~l~~ aWt. RS CAS# 100.00 Oxygen, Compressed No 7782447 tiHGHKL H~ 5~J51~1r,1VlA TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ AMOUNTS AT THI5 LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 60.00 GAL 60.00 GAL oWt . RSI CAS# IlEiGHKL Ei. 7~~,J,J1~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / UnR HAZARDOUS COMPONENTS -5- 02/02/2007 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~mbient ~ Ambient DRUM/BARREL-METALLI~ ,~ F MAACO AUTO PAINTING ~ Inventory Item 0005 COMMON NAME / CHEMICAL NAME WASTE PAINT Location within this Facility Unit SiteID: 015-021-002050 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# Liquid TWaste ~ Ambient~E ~ AmbientT~E DRUM/BARRELEMETALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 35.00 GAL 35.00 GAL 35.00 GAL HAZARDOUS COMPONENTS ~ ~ - zw~. RS CAS# t1HGHKIJ A~~i;•~51~11~;1V'1'S TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / UnR -6- 02/02/2007 F MARCO AUTO PAINTING SiteID: 015-021-002050 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 10/18/2000 ~ I CHECK PAINT ROOM EVERYDAY. Employee Notif./Evacuation 10/18/2000, IF ANY RELEASE CALL 911. Public Notif./Evacuation 10/18/2000 EMPLOYEES ARE TRIANED TO EXIT LOCATION AND CALL 911 IN THE EVENT OF AN EMERGENCY. Emergency Medical Plan 10/18/2000 DR CHANDRASEKAR.AN 327-5401 OR DR EMANUEL DOZIER 859-2211. -7- 02/02/2007 ;. F MAACO AUTO PAINTING SiteID: 015-021-002050 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 10/18/2000 ~ MONTHLY SAFETY MEETINGS. Release Containment 10/18/2000 EVACUATE LOCATION AND CALL 911. Clean Up 06/01/2006 IF SPILL OR RELEASE IS BEYOND OUR MEANS, WILL CALL LOCAL CONTRACTOR TO PROPERLY MITIGATE AND DISPOSE OF. Other Resource Activation -8- 02/02/2007 F MAACO AUTO PAINTING SiteID: 015-021-002050 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ _, _,_ u~~~~a~ ~~a~a~u~ ,.•---~ ..rr • V l.lll Vy JL1UV -V11~7 / .mss ~ ~ L p,~i~i^el'Sn rf in ~ ,ba.~~. ~ ~ 1`~-~. ~~./,~ ~- 7 F• ~~. ~ x~ cr,,, ~,G-~ ~.~,.~ ~~~'"~ Wis. Building Occupancy Level 03/14/2006.= 12 EMPLOYEES -9- 02/02/2007 i -.' ,~ F MAACO AUTO PAINTING SiteID: 015-021-002050 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 06/01/2006 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: VIDEO AND MONTHLY TRAINING SESSIONS. rc~yC. G nclu tVi 1'LLI.l,L1C 1/.7-C 1ZC 1lA tVt t'ul. I.LIC V5C -10- 02/02/2007 UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1: Business Plan and Inventory Program BAKERSFIELD FIRE DEPT Prevention Services a p ~I~s 900 Truxtun Ave., Suite 210 wR>rr >• Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME NSPECTION DATE INSPECTION TIME u c,7'a 1 ~ ~ D ADDRESS HONE NO. O OFEMPLOYEES _ g33, jar? FACILITY CONTACT USINESS ID NUMBER 15-021- UU ~. oSD c, L 12 N W ~ Section 1: Business Plan and Inventory Program ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION • C V (c=Compliance OPERATION COMMENTS V=Violation __ ^ APPROPRIATE PERMIT ON HAND . D BUSIn@SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ ~/ ` CORRECT OCCUPANCY 0 ^ VERIFICATION OF INVENTORY MATERIALS L~/ ^ ~` VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ~ 9 ^ PROPER SEGREGATION OF MATERIAL ~, ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND P OCEDU RES ^ EMERGENCY PROCEDURES ADEQUATE G~ ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION © _ P C ~~ d~ J J ^ SITE DIAGRAM ADEQUATE & ON HAND _ __ ANY HAZARDOUS WASTE ON SITE? EXPLAIN: __ YES ^ NO ~L, ~ ~ . . ,i ~ .~ ~UESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (881) 328-3979 ~'~,~ ~ ~~ Inspector (Please Print) Fire Prevention / 1" In /Shift of Site/Stetion k Bus' rte Responsible PaAy (Please Print) White -Prevention Servieea Yellow -Station Copy Pink - Buaineae Copy FD2048 (Rw. ~/OS) t + MAACO AUTO PAINTING _________________________________ SiteID: 015-021-002050 + Manager ~- BusPhone: (661) 833-1253 Location: 4321 STINE RD Map 123 CommHaz High City BAKERSFIELD Grid: 14C FacUnits: 1 AOV: CommCode: BFD STA 13 SIC Code:7532 EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title BECKY OBSORNE / OWNER DENVER OSBORNE / OWNER Business Phone: (661) 833-1253x Business Phone: (661) 833-1253x 24-Hour Phone (661).665-2685x 24-Hour .Phone (661) 665-2685x Pager Phone (661) 301.-0141x Pager Phone (661) 301-0141x Hazmat Hazards: Fire Press Reac t ImmHlth DelHlth G~/' ~o~O ~ ~!S Contact C' ~ Phone: .(661) 833-1253x ~ MailAddr: 4321 STINE RD State: CA City BAKERSFIELD Zip 93313 %~ Owner •Br Ge~r~ e d- N~~~ ~ Phone: (661) 833-1253x Address 1.0603 FTt`ruT T ~ ~ ~ r~ lS State : CA y ~ Cit BAKERSFIELD Ci ~ y ~ 9~3 i Zi P 93311 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: -------------------------------------- ---------------------------- ~~ Emergency Directives: PROG A - HAZMAT ~~ PROG S - SPRAY PAINT BOOTH /V Do ~ ~ ~~ ~~ ~~~ Based an my inquiry pf these ir+~ividu~ls responsible for 9btaining tt+e InfaPrmatlanarisanally under penalty cif law that I have p examined and am farr~iiis,r with the information submitted and belli~ie the information is true, accurate, and comp ~~a~-~~ 5 - 2~ ~- © ~ Date Signature ~Nr~ ~ ~~, a ~, 2~p6 `1- 03/14/2006 ~'~~~~` ~~~ F Y E ®F ENVIRONMF.NTA ®ERVRICES NT • ~ .'~ UNIFIED PROGRAM INSPECTION CHECKLIST "~~"w ~gti,~d'~ 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 ~~~~~o~ FACILITY NAME to o ~'i NG~ INSPECTION DATE `~J~/7,~OS" ADDRESS 1 PHONE NO. ~,~.~~ 1 ~S3 FACILITY CONTACT_ ~'11)Ct~ Crl ~ /~L- ____ BUSINESS ID NO. I5-21 U- OD ~ZOS-O INSPECTION TIME` a-D 6t~tt ~V_ NUMBER OF EMPLOYEES ~ S' Section 1: Business Plan and Inventory Program Routine ^ Combined ^ Joint Agency ^Minti-Agency [~ Complaint ^ Re-inspection • OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Nd o ~~GC ~ TI ~13E•R~ FCII S J Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability J Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping J Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: d Yes ^ No Explain: Questions regarding this inspection? Please call us at (661) 326-3979 White -Env. Svcs. Yellow -Station Copy Pink -Business Copy ~ //It ~l - lvN~,~ _,d`' r~~A ~_ Business Site Responsible Party i3•A Inspector: o