HomeMy WebLinkAboutBUSINESS PLAN 10/1/2007~~,
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MIDAS MUFFLER-6919 WHITE LN
Manager BRIAN HUGHES
Location: 6919 WHITE LN
City BAKERSFIELD
CommCode: BFD STA 09
EPA Numb:
SiteID: 015-021-001355
BusPhone: (661) 398-0921
Map 123 CommHaz High
Grid: 16D FacUnits: 1 AOV:
SIC Code:7533
DunnBrad:
Emergency Contact
BRIAN HUGHES
Business Phone-:
24-Hour Phone
Pager Phone
Hazmat Hazards:
/ Title
/ STORE MANAGER
(661) 398-0921x
( ) - x
( ) - x
Emergency Contact
KEN JACHIM
Business Phone:
24-Hour Phone
Pager Phone
/ Title
/ PARTNER/OWNER
(661) 837-8969x
(661) 204-7774x
( ) - x
Fire Press
ImmHlth DelHlth
Contact BRIAN HUGHES Phone: (661) 398-0921x
MailAddr: 6919 WHITE LN State: CA
City BAKERSFIELD Zip 93309
Owner VINCENT MILLER BAKERSFIELD LLC Phone: (661) 837-8969x
Address 6919 WHITE LN ~ State: CA
City BAKERSFIELD Zip 93309
Period to
Preparers
Certif'd:
ParcelNo:
Emergency Directives:
PROG A - HAZMAT
PROG H - HAZ WASTE GEN
PROG T - ABOVEGROUND STORAGE TANK
TotalASTs: _
TotalUSTs: _
RSs: No
ENS ®Gfi ~. ~p8~
i3ased on my inquiry of those individuals
responsible fc~r obtaining the information, I certify
under penalty of ia4v that I have personally
examined and am familiar +Nith the information
submitted a.nd believe the information. is true,
accurate, and complete.
_1~~_ _ a-v~-v a
Signature Date
Gall
Gal
-1- 07/12/2007
~;
F MIDAS MUFFLER-6919 WHITE LN SiteID: 015-021-:001355 ~
~ Hazmat Inventory By Facility Unit ~
~ MCP+DailyMax Order Fixed Containers on Site ~
Hazmat Common Name... SpecHaz EPA Hazards. Frm DailyMax Unit MCP
ACETYLENE E F P IH G 1500.00 FT3 Hi
OXYGEN F P IH G 1500.00 FT3 Low
WASTE OIL F DH L 500.00 GAL Low
TRANSMISSION OIL F DH L 110.00 GAL Low
WASTE ANTIFREEZE F DH L 90.00 GAL Low
ARGON/CARBON DIOXIDE F P IH G 715.00 FT3 Min
MOTOR OIL F DH L 110.00 GAL Min
-2- 07/12/2007
-3- 07/12/2007
t. Z
F MIDAS MUFFLER-6919 WHITE LN SiteID: 015-021-001355 ~
~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~
COMMON NAME / CHEMICAL NAME
ACETYLENE Days On Site
365
Location within this Facility Unit Map: Grid:
EXT W WALL AND N WALL & ONE PORTABLE CAS#
74-86-2
STATE T TYPE PRESSURE ~ TEMPERATURE ~~ CONTAINER TYPE
~GaS I Pure Above Ambient I Ambient I PORT_ PRESS_ CYLINDER I
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
300.00 FT3 1500.00 FT3 732.00 FT3
I1tiGL-1CCL V U .7 1. V 1~1Y V1V L" 1V 1 w7
%Wt. RS CAS#
100.00 Acetylene Yes 74862
PL[-~]GtitCL ti. 7.7 L~.7.71~1~1V 1 J
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 on Site ~
COMMON NAME / CHEMICAL NAME
OXYGEN Days On Site
365
Location withi n this Facility Unit Map: Grid:
EXT W WALL AND N WALL & ONE PORTABLE CAS#
7782-44-7
STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
300.00 FT3 1500.00 FT3 I 1300.00 FT3
azr~c~rucLV~~ ~.vrlrvlvalVl~
%Wt• RS CAS#
100.00 Oxygen, Compressed No 7782447
ritiGtiRL 1'iJ .7r+.7.71°1P~1V 1.7
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F P IH / / / Low
-4- 07/12/2007
r. ~
F MIDAS MUFFLER-6919 WHITE LN SiteID: 015-021-001355 ~
~ Inventory Item 0005 Facility Unit: Fixed Containers on Site ~ '
COMMON NAME / CHEMICAL NAME ~
WASTE OIL Days On Site
365
Location within this Facility Unit Map: Grid: '
W WALL S CRNR CAS#
221
Liquid TWaste ~mbient~E ~ AmbientT~E DRUM/BARRELEMETALLI~
AMOUNTS AT THIS LOCATIONI
Largest Con55~00rGAL Daily 500100m GAL 1 - - Daily 110r00e GAL
- tltjGtittLVUS ~vi~irvlv.c,1V l~
°sWt. RS CAS#
100.00 Waste Oil, Petroleum Based No 0
t1E~GHKIJ 1~~~~~51~1~1V1~
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F DH / / / Low
~ Inventory Item 0007
- _ ryn\R111!/~1T 1~TT LlT ~ /YTTTwRT /9TT ITT wtT
Facility Unit: Fixed Containers on Site ~
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
GAL 110.00 GAL GAL
nsyarucLVU~ ~.vrirvlv~lvta
°sWt- RS CAS#
100.00 Transmission Fluid (Petroleum-Based) No 0
I1tiGa`iICL Eia .7L~J.71"12S1V 1 .7
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F DH / / / Low
-5- 07/12/2007
STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE
Liquid TMixtur~Ambient ~ Ambient METAL CONTAINR-NONDRUM
r.
F MIDAS MUFFLER-6919 WHITE LN
~ Inventory Item 0008
COMMON NAME / CHEMICAL NAME
WASTE ANTIFREEZE
Location within this Facility Unit
STATE TYPE PRESSURE
Liquid TWaste ~ Ambient
SiteID: 015-021-001355 ~
Facility Unit: Fixed Containers on Site ~
Days On Site
365
Map: Grid:
CAS#
107-21-1
TEMPERATURE CONTAINER TYPE
Ambient ~STIC CONTAINER
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
90.00 GAL 90.00 GAL 90.00 GAL
ritiGEiKLVU~ wrirviv~ivlJ
aWt. RS CAS#
30.00 Ethylene Glycol No 107211
riHGEiKL Haa~.751~1~1V1~J
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F DH / / / Low
~ Inventory Item 0003
COMMON NAME / CHEMICAL NAME
ARGON/CARBON DIOXIDE
Location within this Facility Unit
SW CRNR AND S WALL & ONE PORTABLE
STATE TYPE PRESSURE _
Gas TMixture Above Ambient
Facility Unit: Fixed Containers on Site ~
Days On Site
365
Map: Grid:
CAS#
7440-37-1
TEMPERATURE CONTAINER TYPE
Ambient PORT. PRESS. CYLINDER
AMOUNTS AT THIS LOCATION
Largest Co350100rFT3 Daily M15100m FT3 ~ Daily A15r00e FT3
iu~uruu~vv.~ L,vl•1rvl~~ty t S _
%Wt- RS CAS#
75.00 Argon No 7440371
25.00 Carbon Dioxide No 124389
ru-~c~ti[cL [-1J J~+.7.7i"iL~1V 1.7
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F P IH / / / Min
-6- 07/12/2007
r, .
F MIDAS MUFFLER-_6919 WHITE LN
~ Inventory Item 0004
COMMON NAME / CHEMICAL NAME
MOTOR OIL
Location within this Facility Unit
W WALL S CRNR
STATE TYPE PRESSURE
Liquid TMixture ~ Ambient
SiteID: 015-021-001355 ~
Facility Unit: Fixed Containers on Site ~
Days On Site
365
Map: Grid:
CAS#
8020835
TEMPERATURE CONTAINER TYPE
Ambient ABOVEGROUND TANK
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum ~ Daily Average
110.00 GAL 110.00 GAL 110.00 GAL
riAGH.ttLVUJ C:V1~lYV1ViS1V15
oWt. RS CAS#
100.00 Motor Oil, Petroleum Based No 8020835
tiHL,1jKL 1'~SJL'~al~lL'1V"15
TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP
No No No No/ Curies F DH % / j Min
-~- 0~/12/200~
r. .
F MIDAS MUFFLER-6919 WHITE LN SiteID: 015-021-001355 ~
Fast Format ~
~ Notif./Evacuation/Medical Overall Site ~
~ Agency Notification 11/16/2000 ~
CALL 911.
Employee Notif./Evacuation 07/07/2006
THE SHOP MANAGER HAS FULL RESPONSIBILITY FOR EVACUATION AND PROPER
NOTIFICATION. IF THE SHOP MANAGER IS INJURED OR UNAVAILABLE, THE ACTING
SHOP MANAGER WILL BE IN CHARGE. CALL 911.
Public Notif./Evacuation
07/07/2006
MANAGER OR ACTING MANAGER WILL PHONE POLICE AND FIRE DEPT OR CALL 911. ALL
PERSONS WILL BE EVACUATED TO THE NORTH OUT OF ALL EXITS AWAY FROM WELDING
GAS BY SHOP PERSONNEL.
Emergency Medical Plan 11/16/2000
MERCI MEDI CENTER.
-8- 07/12/2007
F MIDAS MUFFLER-6919 WHITE LN SiteID: 015-021-001355 ~
Fast Format ~
~ Mitigation/Prevent/Abatemt Overall Site ~
~ Release Prevention 07/07/2006 ~
GAS IS KEPT IN PRESSURIZED BOTTLES, OXYGEN IS RIGHT-HAND, ACETYLENE IS
LEFT-HAND VALVES.
f
Release Containment 07/07/2006
GAS IS STORED IN APPROVED PRESSURE CONTAINERS. SHUT-OFF VALVES OF 02,
ACETYLENE TO STOP FLOW OF GASES. IF VALVE IS BROKEN, FILL HOLE ONCE
PRESSURE IS RELEASED. SPREAD FLOOR SWEEP (ABSORBENT) OVER AREA WEARING
PROTECTIVE GLOVES AND EYEWEAR.
Clean Up
07/07/2006
MOP/SPONGES: WRING OUT IN CONTAINMENT BARRELS. AIR OUT SURROUNDING AREA,
KEEPING PEOPLE AT A DISTANCE. UPON FULL ABSORBTION, SHOVEL UP AND PLACE IN
PLASTIC CONTAINER. DISPOSE OF IN PROPER MANNER.
v~.iic1 iccavul~c til:l.lVCLl.1V11
-9- 07/12/2007
., ...
F MIDAS MUFFLER-6919 WHITE LN SiteID: 015-021-001355 ~
Fast Format ~
~ Site Emergency Factors ,Overall Site ~
w7jJ~'C:1d1 IiciGdL U.y'
Utility Shut-Offs 04/02/2007
GAS - NW CRNR INSIDE
ELECTRICAL - NW CRNR INSIDE .
WATER - W SIDE OUTSIDE
Fire Protec./Avail. Water
PRIVATE FIRE PROTECTION - 3 FIRE EXTINGUISHERS IN SHOP AREA.
FIRE HYDRANT - NW CRNR OF PROP.
07/07/2006
Building Occupancy Level
7 EMPLOYEES
07/07/2006
-10- 07/12/2007
7 . . R
F MIDAS MUFFLER-6919 WHITE LN SiteID: 015-021-001355 ~
Fast Format ~
~ Training Overall Site ~
~ Employee Training 07/07/2006 ~
MATERIAL SAFETY DATA SHEETS ON FILE.
BRIEF SUMMARY OF TRAINING PROGRAM: DESCRIPTION OF SHUT-OFF VALVES,
EXPLANATION OF HIGH PRESSURE AND GENERAL SAFETY, DESCRIPTION OF AUTHORITIES
PHONE NUMBERS.
rays ~
c
Held for Future Use
Held for Future Use
-11- 07/12/2007
~?n,~s,,,,,,; yT~'
MIDAS MUFFLER-6919 WHITE LN
Manager BRIAN HUGHES
Location: 6919 WHITE LN
City BAKERSFIELD
CommCode: BFD STA 09
EPA Numb:
~~~
SiteID: 015-021-001355
BusPhone: (661) 398-0921
Map 123 CommHaz High
Grid: 16D FacUnits: 1 AOV:
SIC Code:7533
DunnBrad:
Emergency Contact / Title Emergency Contact / Title ur~
BRIAN HUGHES / STORE MANAGER KEN JACHIM / (~P CI
Business Phone: (661) 398-0921x Business Phone: (661) 837-8969x
24-Hour Phone ( ) - x 24-Hour Phone (661) 204-7774x
Pager Phone ( ) - x Pager Phone ( ) - x
Hazmat Hazards : - °-~ - - _.__ __ _ , __ _ Fire Press ImmHlth De1H1th
Contact
N ~+ zvv ~~~~ ~ ~S Phone: (661) 398-0921x
MailAddr : 6919 WHITE L State : CA
City BAKERSFIELD Zip 93309
Owner VINCENT MILLER BAKERSFIELD LLC Phone: (661) 837-8969x
Address 6919 WHITE LN State: CA
City BAKERSFIELD Zip : .93309
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif'd: RSs: No
ParcelNo:
Emergency Directives:
PROG A - HAZMAT ~N~'~
PROG H - HAZ WASTE GEN
~ ~~~7
PROG T - ABOVEGROUND STORAGE TANK
F3ased on my inquiry of those individuals
responsible for obtaining the information, I certify
under penalty of law that I have personalty
examined and am fam'sliar with the information
submitted and believe the information is true,
accurate, and complete.
=/ .~ ~j~r
Signatur Date
-1- 02/05/2007
;L l Y:
Es3'~o7
+ MIDAS MUFFLER =-- __________________________________ SiteID: 015-021-001355 +
L~ir-ra~ ~~y5 ors
Manager BusPhone: (661) 398-0921
Location: 6919 WHITE LN Map 123 CommHaz High
City BAKERSFIELD Grid: 16D FacUnits: 1 AOV:
CommCode: BFD STA 09
EPA Numb:
SIC Code:7533
Dta,nnBrad
+_______________________________________+_______________________________~=~~~o
Emergency Contact / Title Emergency Contact / Title ~ cc~
JORGE RIOD / MANAGER ,~~~ KEN JACHIM /
Business Phone: (661) 398-0921x Business Phone: (661) 837-8969x
24-Hour Phone ~3s8? 24-Hour Phone (661) 204-7774x
~
Pager Phone (~~ Pager Phone ( ) - x '
Hazmat Hazards: Fire Press ImmHlth DelHlth
Contact ~d'ian- 1~~. ~-r~ Phone: (661) 398-0921x
MailAddr: 6919 WHITE LN State: CA
City BAKERSFIELD Zip 93309
Owner VINCENT MILLER BAKERSFIELD LLC Phone: (661) 837-8969x
Address 6919 WHITE LN State: CA
City BAKERSFIELD Zip 93309
Period to TotalASTs: = Gal
Preparers TotalUSTs: = Gal
Certif'd: RSs: No
~ ParcelNo:
Emergency Directives:
PROG A - HAZMAT
PROG H - HAZ WASTE GEN
PROG T - ABOVEGROUND STORAGE TANK
Based on my inquiry of those indlviduais
responsible for obtairnng the information~rsonally
under penalty of law that 6 have pe
examined and am familiar with the information
submitted and believe the information is true,
accurate, and complete.
0
Date
Signature n ~ Cj~a ~~
ENT ~v~ p 7
2006
D
~~"°p~~
~S~a~
-1- 03/13/2006
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
_ _ __ __
_~__ _ ~ D A"~----- _ i ~_ t`t_ 03 ~ l~~a
ADDRESS ----- ---...------- -- -- ------_ __ ----._._ ... .. _.. _. -------- - --~ - --- --- ---'- PHONE o.-- - --~ No~of Employees --
FACILITYCONTACT 0~----------------°--- -- - -- ---------------
Business ID Number
_...~ ~ ~~~ ~ o ~ 15-021- QQ I ~S
Section 1: Business Plan and inventory Program
outine ^ Combined ^ Joint Agency ^Mnlti-Agency O Complaint ^ Re-inspection
OPERATION
C V
n~
t COMMENTS
\V=Vioa
on
/
~^ APPROPRIATE PERMIT ON HAND
L7 ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE
~^ VISIBLE ADDRESS
L7 ^ CORRECT OCCUPANCY
~^ VERIFICATION OF INVENTORY MATERIALS
r -- - - -~--------------
L7 ^ VERIFICATION OF QUANTITIES _---------------- -------------------------...----------
^ [dam VERIFICATION OF LOCATION
^ ~ PROPER SEGREGATION OF MATERIAL
fd ^ VERIFICATION OF MSDS AVAILABILITYE
^ VERIFICATION OF FIAT MAT TRAINING ~~..T- M ~ 2--1~ c :~J ~ S
^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
(~^ EMERGENCY PROCEDURES ADEQUATE
^ O~CONTAINERS PROPERLY LABELED
- ------ ---- ------
--- ---
-
-
--
-
^ Lr'l F'IOUSEKEEPING
i ~~~~T~~N ~~ 1 ~~~5 `---------
^ ^ FIRE PROTECTION
- / --------
^ Id' SITE DIAGRAM ADEQUATE & ON HAND -- -----------------------~-1-- ---- - ~ 3
~ ~ ~~~ ~T ~ \ y ~ o
~/ ~~yy
ANY HAZARDOUS WASTE ON SITE?: [BYES ®'~10 /
EXPLAIN: ~JA-ST~ D~L-
i
QUESTIONS/R~EGARDING THIS INSPECTIONS PLEASE CALL US AT ~66'I~ 326-3979
Inspector Bad~g~~e N~oLLL.
White -Environmental Services Yellow • Station Copy
eu ess Site Respo, ns ble Party J
~~
P -Business COPY
IED PROGRAM INSPECTION CHECKLIST
•SECT~N 1: Business Plan and Inventory Program
BAKERSFIELD FIRE DEPT
Prevention Services
~/t~ 9001Yuxtun Ave., Suite 210
~Rr~I ~ Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 872-2171
FACILITY NAME NSPECTION DATE
-y-vs INSPECTION TIME
m~D,4.S rn ~,,z
ADDRESS ~ ~' ~ ~~ l ~~ ~ ~ HONE NO.
3ya - o ~ z ~ O OF EMPLOYEES
C~
FACILITY CONTACT
e~l ~ y~.~ _ y~z~
~
J o
4 USINESS ID NUMBER
15-021- /3~ J-o
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Section 1: Business Plan and Inventory Program
ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION
C V ~ C=Compliance OPERATION
V=Violation COMMENTS
_ ___
I~ ^ APPROPRIATE PERMIT ON HAND
LtY ^ BUSIrI@SS PLAN CONTACT INFORMATION ACCURATE
~ ^ VISIBLE ADDRESS
-
L
7
^ CORRECT OCCUPANCY
,
,
,/
Lr7 ^ VERIFICATION OF INVENTORY MATERIALS
L4' ^ VERIFICATION OF QUANTITIES
^ VERIFICATION OF LOCATION
G~
^ PROPER SEGREGATION OF MATERIAL
/
L~
(
^ VERIFICATION OF MSDS AVAILABILITY
__
//
.
I
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Q
^ VERIFICATION OF HAZ MAT TRAINING
,
.
,/
Ud ^ VERIFICATION OF ABATEMENT SUPPLIES AND
PROCEDURES
l1~ ^ EMERGENCY PROCEDURES ADEQUATE
^ CONTAINERS PROPERLY LABELED
^ HOUSEKEEPING
^ FIRE PROTECTION
^ SITE DIAGRAM ADEQUATE 8 ON HAND
ANY HAZARDOUS WASTE ON SITE? f~'YES ^ NO
EXPLAIN: ~'41'T'4." O t ~' ~Q. ~ l~'„ ~'~ ~+ ~ --
~UESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979
S . ~/,~ ~ z. ~ ~
Inspector (Please Print) Fire Prevention / 18t In / Shift of Site/Station It Business Sit h I e Responsible Pa (Please Print)
White -Prevention Services Yellow -Station Copy Pink -Business Copy FD2049 (Rav. 02105)
UNIFIED PROGRAM INSPECTION CHECKLIST:
SECTION 1: Business Plan and Inventory Program
Prevention Services
A ~ a s F , , „ 900 Truxtun Ave., Suite 210
FIRE Bakersfield, CA 93301
ARTM r -Tel.: (661) 326-3979
Fax: (661} 872-2171
FACILITY NAME ~ ~~~ ~ U~~ /~ ` ~ ~ ~ ~ ~ `~ ` /t
L (('//rWWn y/INI^'_~/
V,~ INS ACT Oi D(~A~
` INSPECTI~ TIME
3
ADDRESS ~ _ q
V (~ / W (mil ~~ C.~ PHONq N
O. /
~ L i~~~~-1 NO O
EMPLOYEES
FACILITY CONTACT
~~-/Ztl~-ns ~vGI~~S BUSINESS ID NUMBER -
15-021- /3s',~
Section 1: Business Plan and Inventory Program
-•- - __
ROUTINE ^ COMBINED ^ .JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION
L i
C . V ~ C=Compliance OPERATION
V=Violation COMMENTS
I~ ^ APPROPRIATE PERMIT ON HAND
i~ ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE
i3 ^ VISIBLE ADDRESS
r
~' ^ CORRECT OCCUPANCY _ ~ `
0 ^ VERIFICATION OF INVENTORY MATERIALS
~ ^ VERIFICATION OF QUANTITIES
^ VERIFICATION OF LOCATION -
^ PROPER SEGREGATION OF MATERIAL
^ VERIFICATION OF MSDS AVAILABILITY
i~ ^ VERIFICATION OF HAZ MAT TRAINING
i~`
^
VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES 1
1
111
la ^ EMERGENCY PROCEDURES ADEQUATE
^ CONTAINERS PROPERLY LABELED
~ ^ HOUSEKEEPING
Q ^ FIRE PROTECTION
CLY ^ SITE DIAGRAM ADEQUATE & ON HAND
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 ~/////~
Inspector (P se Print) Fire Prevention / 1~~ In /Shift of Site/Station # Business Site esponsible Party (Please Print)
White.- Prevention Services Yellow -Station Copy Pink -Business Copy FD 2155 (Rev. 09/05
ANY HAZARDOUS WASTE ON SITE? YES ^ NO