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UNIFIED PROGRAM INSPECTION CHECKLIST' F, 900 Truxtun Ave.
Suite 210
0
a .9 e a 5
-FIRE ,
Bakersfield, CA 93301
SECTION- 1: Business-Plan and Inventory Program "R'M Tel.: (661) 326-3979
F
661
872
2171
ax: (
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- I FACILITY NAME; ;INSPECTION DATE IINSPECTIONTIME;: -
. ADDRESS
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~ _ IPHONE NO. NO OF EMPLOYEES
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. FACILITY CONTACT BUSINESS ID NUMBER ~ -
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~ 15-021- Q p 6 l~~ _
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I Section 1 Business Plan and Inven tory Program ~ ~ I
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~L~(JROUTINE ^ COMBI
NED ^ JOINT AGENCY ^ MULTI-AGENCY
^ COMPLAINT
^ RE-INSPECTION
C V (C=compiiance~ OPERATION
V=Violation COMMENTS ~i
^ APPROPRIATE PERMIT ON HAND ~ ~~~ I _ ~
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^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE j~ r
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^ VISIBLE ADDRESS ~ ~ l ~ / /
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^ CORRECT OCCUPANCY
^ VERIFICATION OF INVENTORY MATERIALS
^ VERIFICATION OF QUANTITIES
^ VERIFICATION OF LOCATION
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^ PROPER SEGREGATION OF MATERIAL I
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^ VERIFICATION OF MSDS AVAILABILITY ~ 1 A,~ _ _! ~~~
,v ~P/Y' ~~ ~~~
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L VERIFICATION OF HAZ MAT TRAINING ! `
^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES I
^ EMERGENCY PROCEDURES ADEQUATE II
^ CONTAINERS PROPERLY LABELED
^ I-IOUSEKEEPING
^
' ~ FIRE PROTECTION ~ 1
~ GilS'~ i O[~iT Q~o -~.~1@ ~~T
^ SITE DIAGRAM ADEQUATE & ON HAND ~ I
ANY HAZAR~~I1DOUS WASTE ON SITE? /AYES ^ NO
EXPLAIN: l~- ~ O.S, ~ I~ci5~- D. ~ ~ L`~LLL ~~~,.~'
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QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979
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Inspector (Please Print) Fire Prevention / 1~' In /Shift of Site/Station #
White -Prevention Services Yellow -Station Copy Pink -Business Copy _
FD 2155 (Rev. 09/OS
UNIFIED PROGRAM INSPECTION CHECKLIST ~
:~.: - ,~~
SECTION 1 Business Plan and Inventory Program
r~
LJ
Bakersfield Fire Dept.
Environmental Services
900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
-Tel: X661) 326-3979. _ __ _
FACILITY NAME
,~ t ^ WSPECT ON GATE
~ INSPECTION TIME
~ o
ADDRESS
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~
~
-5
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~~~
-~~~ PH E No.
~=~3 ~J No. of Empbyees
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FACILITYCONTACT ------
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----- -- -- ~-- .
---
----------
-
Business ID Number
S ~„ 15-021- d o i~ ~ ~
Section 1: Business Plan and Inventory Program
Routine O Combined ^ Joint Agency DMulti-Agency ^ Complaint ^ Re-inspection
•
C V OPERATION
n~ ~ COMMENTS
\V=Vioation
l
~$
O7 ^
APPROPRIATE PERMIT ON HAND
I
^ BUSINESS PLAN CONTACT INFORMATION ACCURATE
---- ---
^ ------- - -- ----- ---- -- -....-- ---_ _ __ -
VISIBLE ADDRESS -
! r _... - -- -- _--......_. _. .... .. - - --- .
^ CORRECT OCCUPANCY
^ ~ VERIFICATION OF INVENTORY MATERIALS
~' ^ VERIFICATION OF QUANTITIES
~j ^ .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 - 1. - - - - - - .._ _.
~
l
_______.
^ _.....___.__.___._.__ _...._____.._......__.______________.. _.___.__
CONTAINERS PROPERLY LABELED -._.
-__..__...____ __..___... ._. .__. ..._
~
^ ~ HOUSEKEEPING !
^. FIRE PROTECTION !
I
^ SITE DIAGRAM ADEQUATE ~ ON HAND
ANY HAZARDOUS WASTE ON SITE?: ^ YES ~ NO
EXPLAIN: ~(tA°' G`'~'C/d .. AC2, i dI fe~f B'
• QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT 661 326-3979
---------- - ~~------------- ----.._.---cl__'.._-..-_.._.___..._- ---
Inspect Please Print Fire Prevention 1st-tn/Shin of Site
White - EnvironmenUl Services Yellow -Station Copy
usiness vW sible Party (Please Print)
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Pink -Business Copy