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Home My WebLink AboutINSPECTIONS,~ r UNIFIED PROGRAM .INSPECTION CHECKLIST SECTION 1: Business Plan and Inventory Program Prevention Services A r; R S F , „ - .900 Truxtun Ave.,, Suite 210 iFiRE Bakersfield, CA 93301 o AerM Tel.: (661) 326-3979 . - ' ~ Fax: - (661) 872-2171 FACILITY NAM ' ~ II ~ ~ INSPECTION DATE - 4 " ~ INSPECTION TIME o• C3 t0l~l I ~I G ^ Q ( ADDRESS ~ ~ ~ ~ ( ~ ~ ~ - - - _ PHONE NOi ,~~~~ 3 NO OF EM~YEES FACILITY CONTACT ~ - BUSI ESS ID NUMBER 45-021- 4k _- __ _ __ __-_ _ -- __ _I Section 1: Business Plan and Inventory Program ~ ^ ROUTINE C~C~OMBINED ' '^ .JOINT AGENCY' ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION l C V ~ C=Compliance OPERATION V=Violation COMMENTS Ql/ ^ APPROPRIATE PERMIT ON HAND ~ / LU/ ^ BUSIneSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF. INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL " / LY/ ^ VERIFICATION OF MSDS AVAILABILITY ~; ~I ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES 1 ~ (~/ ^ EMERGENCY PROCEDURES ADEQUATE ~^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING FIRE PROTECTION ` -f -6. ~irc. ~`~ - C'~t ^ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES C~NO EXPLAIN: QUEST~NS REGARDING THIS INSPECTION? PLEASE CALL US AT ,(661) 326-3979 Inspector (Please Prin Fire P Ion / 1s' In /Shift of Site/Station # usiness Site /Responsible Party (Please Print) ' - White -Prevention Services ~ Yellow -Station Copy ~ Pink -Business Copy - FD 2155 (Rev. 09/05 k `~,"~ INSPECTIONS B E R S F I D BUSINESS PLAN & ~RrM r INVENTORY PROGRAM UNIFIED PROGRAM INSPECTION CHECKLIST FACILITY NAME: ~n rir ~~~ ~~GI, INSPECTION DATE: Q d Section 2: Underground Storage Tanks Program ^ Routine C1YCombined ^ JointA ency ^ Multi-Agency 3Complaint ^ Re-Inspection Type of Tank C~.~ Number of Tanks Type of Monitoring ~ (S"~ Type of Piping ~~~ ~, t'~. OPERATION C V COMMENTS Proper tank data on file Proper owner /operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? ^ Yes `'~ No Section 3: Aboveground Storage Tanks Program Tank Size(s) Type of Tank Aggregate Capacity Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF?) If yes, does tank have overfill /overspill protection? C =Compliance V =Violation Y =Yes N = No Inspector: Questions regarding this inspection? Please call us at (661) 326-3979 White -Prevention Services BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 ' Fax: (661) 852-2171 Page 1 of 1 siness Site Responsible Party Pink -Business Copy KBF-7335 FD 2156 (Rev. 09/05) ~* BASERSFIELD FIRE DEPT ~s~ ~ a Prevention Services IDNIFIED PROGRAM INSPECTION CHECKLIST ' rr~t~ 9oolYuxtunAve., Suite 210 ~~,...::~,. ~::;:~~ : t.,. <- ~ ._. , ,:, ~.,. ,- ..... .... ...... .:. :~ ._.- . ...<. :_._:..: sRrr Bakersfield. CA 93301 SECTION 1: Business Plan and Inventory Program ~ Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NA NSP ON ATE INSPECTION TIME ADDRESS ~ ~ / I ~` ~ `K~C_~ HO~NO. ~ ~ ~ ~ r O OF E PLOYEES FACILITY CONTACT USINESS ID NUMBER 15-021- Section 1: Business Plan and Inventory Program ~5 ~f D ^ ROUTINE OMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (c=Compliance OPERATION V=Violation COMM NTS ^ APPROPRIATE PERMIT ON HAND ~^ BUSin@SS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ~A~~~ SIN 1 ~~I Q~~ ^ VERIFICATION OF INVENTORY MATERIALS _ ~ ~~ ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ ^ PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITY - / 6Y ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND RO EDURES " EMERGENCY PROCEDURES ADEQUATE CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ ^ FIRE PROTECTION SITE DIAGRAM ADEQUATE & ON HAND ,, ~~~,,~ (j,~,,, ~~,~~ a~ --~~~~9~~-~Q-6LL1C1~1-~-5]!SL[ISLd._ ~ u ANY HAZARDOUS WASTE ON SITE? EXPLAIN: ~ _~ ^ YES C6::1~0 r~s'c"~ QUESTI REGARDI G T IS INSPECTION? PLEASE CALL US AT (881) 326-3979 Inspector (Please Print) Fire Prevention / i" In / Shift of SRe/Stetion # mess SRe/School Site Responsible Party (Please Print) White -Prevention Services Yellow -Station Copy Pink -Business Copy FD2l)48 (Rev. 02105) ~. = .- ~.F.LD ~:- ~++w,Q`~' `r~'~~\ (:ITY ®F BAK.EI2SFIEI,U FIRE DEPAR'I'MF,NT ~~ ~ ~ ~°~ OFFICE OF >h;NVIRf)1Vli'IENTAL SERVICES ~~' '~+` UNIFIED PROGRAM INSPECTION CI~ECKLIST ~`-,w ~g~,~'~~ 1715 Chester Ave., 3''`' Floor, ~akerstield, CA 93301 ...,~~ FACILITY NAME A,.ICC'~ S`~ ~8~f ~~ INSPECTION DATE Section 2: Underground Storage Tanks Program ^ Routine ~ombined ^ Joint Agency ^Mulfi-Agency Complaint ^ Re-inspection Type of Tank ,gu~,~. C~ . P Number of Tanks Type of Monitoring ~~( C'~ Type of Piping S ~ , OPERATION C V COMMENTS Proper tank data on tile. - Proper owner/operator data un file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current ~ ~ , ~ ~ ~ ` Failure to correct prior UST violations Has there been an unauthorized release? YeS NO L~ Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OF,S Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Inspector: Office of Environmental Services (661) 326-3979 usiness Site Responsible Party white - F nv. Svcs. Pink -Business C~~pv ~, ~'-- UNIFIED PROGRAM INSPECTION CHECKLIST~~' 3.E"~..,,..t^.:igA'.PW.tif:1'3Rn'?l.~vabF«;•.Ft .~.{ .,, '.~:.~-.. ":. .d. -e.:. ..'.tt ...._..;.: w+~. ~'. .•- .~ .. A... .SECTION 1: Business Plan and Inventory Program BASERSFIELD FIRE DEPT Prevention Services ~~~~ 9001Yuxtun Ave., Suite 210 ~t>rr Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAM 2 r NSPECTION DATE --o INSPECTION TIME ,.3 ADDRESS HONE NO. O OF EMPLOYEES ~~ ~ FACILITY CONTACT ~ USINESS ID NUMBER ,5-02,- q~ Section 1: Business Plan end Inventory Program ^ ROUTINE COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (~=Compliances OPERATION V=Violation COMMENTS ,~ ^ APPROPRIATE PERMIT ON HAND ~(. ^ BUSIfieSS PLAN CONTACT INFORMATION ACCURATE /~ ^ VISIBLE ADDRESS ' \ ^ CORRECT OCCUPANCY fy~( ~/ ~ ^ VERIFICATION OF INVENTORY MATERIALS ,~( (/ ~ ~ ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL /R3, ^ VERIFICATION OF MSOS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PR CEDURES ^ EMERGENCY PROCEDURES ADEQUATE _ T~ y ~J O CONTAINERS PROPERLY LABELED ~ e ~D ^ HOUSEKEEPING ^ FIRE PROTECTION ~^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZA,FiDOUS WASTE ON SITE? ^ YES ^ NO EXPLAIN:.~~~1 ~-~G7//~~~_~~~Q ~ -. ~ .~~~.i~ ~c ,~-._--~.~~~ - QUESTIONS REG/AlRDING THIS INSPECTION? PLEASE CALL US AT (881) 326-3879 Inspector (Please Print) Fire Prevention / 1" In / Shift o) Sfte/Stetion k ~usiness SRe/School Site Responsible PaAy (Please Print) White -Prevention Services Yellow -Station Copy Pink - Business Copy FD2049 (Rev. OZ/t15) ~. ~• - w ~ '4 ,i~~' `~~ ~ CITY OF BAKERSFiELD 1' 1RE DEPARTMENT e ~ ~°~~~ OFFICE OF E:NVIRONI~~IF.NTAL SERVICES ~' y~' UNIFIED PROGRAM INSPECTION CHECKLIST _c~ ~gti,,e'A 1715 Chester Ave., 3~`' Ftoor, Bakersfield, C:A 93301 FACILITY NAME~~}Kf~2 ,~'i/t7~~nnJ ~~/[.r.-~~ INSPECTION DATE_1_~~~ Section 2: Underground Storage Tanks Program ^ Routine ~Eombined ^ Joint Agency ^Mulfi-Agency ^ Complaint ^ Re-inspection Type of Tank 5~:~,I~ ovAll ~~a-`~ L~ti Number of Tanks ~ Type of Monitoring 6r) b,4RLo Type of Piping S~ ~~~w.Ql( OPERATION C V COMMENTS Proper tank data on file Proper ownen`operator data on file Permit fees current Certification ot• Financial Responsibility ~~ ~ ~(„/ ~ry¢ 1 S Monitoring record adequate and current a2 _ Maintenance records adequate and current Failure to correct prior UST violations ,(~~ ' Has there been an unauthorized release? Yes ~~ U ~~~ Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling (s tank used to dispense MVF? If yes, Does tank have overfill/overspill protection'? C=Compliance V=Violation Y=Yes N=NO Inspector: N ~,,,~ Oi~ice of Environmental Services 661) 326-3979 wI11rC - 1=nV. SVCS. Pink -Business Cory f'" usiness Site Responsible Party ' ITY OF BAKE{I FIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 NSPECTION RECORD POST CARD AT JOB SITE Facility ~'C3'3__ ,~'"~q'lc, a~ ~'t~r Owner Add.ss G ~ I ~ ~C~ Add~ City, Z}~ City, Zip -' INSTRU~IONS: Ple~e call roran ins~lor only when ~h ~up ofins~fions with the ~e numar am ~dy. ~ey.will mn in conseculive o~er beginning wilh number I. ~ NOT cover wo~ tbr ~y numbe~ ~up umil all ile~ in I~I ~up am si~ offby the Pe~iuing AulhoHly. Following these instructions will number or ~ui~d ins~lion visits ~d lh~mtb~ p~enl ~menl ora~i~ional r~. . _ TAN~ AND BACKFILL : INSPE~ION: .: DATE 'INSPECTOR .... " BackfillofT~k(s) "~ -::" "' : '''' : ;"" ' - .. :.....:' ...~'..=~;:-L '?.' ..... Sp~ T.t C~.ifi~i~ ~r'M~ur~tu~ M~ "J ~-~c-'_ :;J~.J ;~ ~.-:~ .:~'. -. ;~. '~' ........ - Cath~ic P~t~ti0n of T~k(s) ' "' ": .? , .... ' '. ' ' ' PIPINGSY~EM ". .... ":¢.. ..... .~.. ... Piping & Race~y. w/Collation S~mp :, .~ .' .':, ;':-:'~'.':= ~: '~ ::?.~:~ ' :' · Cat'lc ~t~ti°'~' ~y~te~Pi~i~ '~?, '" "'~-.-: '. '~;?.?;~:'~- q ';.~ '.=''~ .-~:, ~..;' ~ '?i'~ Dis~nser P~ ";: ~" · '":"-? , ,'. ',:: -'~ " ' " SECONDARY CO~AINME~, O~ILL PROTE~ION, LEAK DE~ION - " ,' . :. -, ,', .~; Liner lns~llation -"T~k(s)' h ~. ?' "- .. ;.~- '% · '. ': '-': '; ................. .. - Liner Installation-Piping"' :'-:. ' ;""" - - ' '."· ' ': .... .~"~ J i' ' _ _ · . .. ' , '- . , , %?; '~,,~'~,~: P~uct Compatible Fill Box(~) ' '..' :... Leak ~t~toffs) for Annual Space-O.W. T~k(s) ............ Monitoring Well(s~sum~s) - H20 Test .:: Leak ~tection ~vic~s)~or Vados~Gmundwater ' . . Spill Prevention Box~ ' FINAL Monitod.g: Fill Box L~k Monitodng Requi~men~ Type UtOtem.+ ~'t~ RECORI . INSPECTION Bakersfield Fire Dept. 1715 Chester Ave. Bakersfield, CA 93301 FACILITY NAME: MANAGER NAME: FACILITY PHONE BUSINESS OWNER NAME, ADDRESS, ZIP CODE BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS, ZIP CODE, PHONE No. OCC TYPE ·[ OCC LOAD No. OF FLOORS I HI RISE BLDG. I RISER DATE I I YES I-I NO El I VIOLATION NOTICE CORRECTION: DATEOFREINSPECTION 3. 10. 11. 12. 13. 14. 15. NOTES CUSTOMER: ,'~ ?--~:j'~ ['~ .C?-Li~/~'7 ~ FIRE PI~EV~NTION SERVICES INSPECTOR: ~ t'~J~S ¢,~ No. "~' (661) 326-3979 WHITE ORIGINAL-OWNER YELLOW-INSPECTOR'S COPY PINK-FILE FD1952 Bakersfield Fire Dept. UNIFIED PROGRAM INSPECTION CHECKLIST I Enb'onmenta] Services '== ' "" '" "'"""' ' '" ' ' ' ' ""' "' "'i 17 !5 Chester ^ye SECTION 1 Business Plan and Inventory Program Bakersfield, CA 9330] Teh {661)326-3979 [~.FACR. ITY NAME IINSPECTION OATE t INSPECTION TIME · / ' 15-021- Section 1: Business Plan and Inventory Program ~ Routine '~ Combined ~ Joint Agency ~ Multi-Agency I~ Complaint r'l Re-inspection C V [ C=Compliance '~ OPERATION COMMENTS ~, V=Violation s ......................................................................................................................................... -'~ VERIFICATION OF MSDS AVAILABILI~E CONTAINERS PROPERLY ~BELED ~ SITE DIAGRAM ADEQUATE & ON HAND ANY H~ARDOUS WASTE ON SITE?; ~ YES ~No EXPLAIN: ..... InspectOr ............ ~dg~-~'~:: ............ --~~ Party White. Environmental Services Yellow - Station Copy Pink - Business Copy CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CltECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILFI'Y NAME (~CC ,~q~.,4-lo/q ~--~- INSPECTION DATE q'3O 03 Section 2: Underground Storage Tanks Program [] Routine ' [~ Combined~[],_Joi, 0.~/ Agency [] Multi-Agency [] Complaint [] Re-inspection Type of Tank ,SUdta. ~¢ · Number of Tanks 3 Type of Monitoring ,~T'(w Type of Piping ,.60dS (~ d,., P. } OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Pennit tees current Certification of Financial Responsibility / Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations / Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance /] V=Violation Y=Yes N=NO //// Inspector: ...~ d&_J'~ _ Office of Environmental Services (661) 326-3979 '"'"'Business Site Responsible Party White - Env. Svcs. Pink - Business Copy UNIFIED PROGRAM INSPECTION CHECKLIST SSE TION 1 Business Plan and Inventory Program FACII.iT`r' NAME __ ~~~Cc_r._.__-S-~t~~{.C_N--- __._~.1~.~ --- - - - ---- .- -- i -_. _-_ ADCRESS 13~ - - - ~.3~-- c~ ~ ~----~ --------- - -- _.- _.. _. ---- -- ---- -- -- FAl'ILITYCONTACT Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 I SPECTION DATE INSPECTION TIME PHONE No. j No. of Employees ~3i_=~ 1~s_~._ - - - _ __--- --- Business ID Number l 5-02 l - ~~'/~ Section 1: Business Plan and Inventory Pt-ogram ^ Routine Combined ^ Joint Agency ^Mnlti-Agency ^ Complaint ^ Re-inspection C V ~ V=V o ationnce l OPERATION i i ~ ^ APPROPRIATE PERMIT ON HAND BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY I LY ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION --_-- - ~^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITYE VERIFICATION OF FIAT MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ ^ FIRE PROTECTION D ^ SITE DIAGRAM ADEQUATE & ON HAND COMMENTS ANY HAZARDOUS WASTE ON SITE: ^ YES L'9 NO EXPLAIN: QUESTIONS R ARDIN TH INSPECTIONS PLEASE CALL US AT ~GG'I ~ 326-3979 - - - -- --- - -.__...__ ._.-.. . - ---- -- ~ ~ r Inspector Badge No., Business Sit R sponsible Party While -Environmental Services Yellow - Stettin Copy Pink - Business Copy ~~~~ ~ ~ ~, w •~ 00 CITY OF BAKERSFIELD FIRE DEPAR"I'MENT OFFICE OF E;NVIRONI~'IF.N"1'Al. SERVICES UNIFIED PROGRAM INSPECTION CHECKI.[ST 1715 Chester Ave., 3"' Floor, Bakersfield, CA 93301 FACILITY NAME ~CI~E ~t~~lcnl ~l~C-T Section 2: Underground Storage Tanks Program INSPEC"1-IUN DATE~~ ~ 3 ^ Routine (~ Combined ^ Joi''{ Agency ^Molti-Agency ^ Complaint ^ Re-inspection Type of Tank Swfi ~ ~ . p I Number of Tanks 3 Type of Monitoring ~(~ Type of Piping SCys ~ C • P OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Pennit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations / Has there been an unauthorized release? Yes NU ~f Section 3: Aboveground Storage Tanks Program TANK SIZE(S) TYpe of Tank AGGREGATE CAPACITY Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection'? C=Compliance V=Violation Y=Yes N=NO Inspector: Office of Environmental Services (661) 3 6-3979 White - inv. Svcs. ~'.~.Z ~.~ ~v Business Site Responsible Party Pink -Nosiness Cory CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKI~IST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME 0)a~tc .h~O'~ ~L~ INSPECTION DATE f-o~3'O'~ ADDRESS &.E,.c ,5'T PHONE NO. ~31- i'I?g- FACILITY CONTACT BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program {~ Routine ~°mbined [~ Joint Agency ~ Multi-Agency ~ Complaint I~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand ( 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 availability Verification of Haz Mat training L Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping ~.. Fire Protection I Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: [~ Yes [~ No Explain: [/~~ Questions regarding this inspection? Please call us at (661)326-3979 -Business Site/~. esponsjble Party CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME {~.C.~' .qlu:t_JdO'~ INSPECTION DATE q" Section 2: Underground Storage Tanks Program [] Routine [~ombined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection Type of Tank ~O.}.c~ Number of Tanks Type of Monitoring _~TC~ Type of Piping OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Permit fees current / Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release.'? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY' Type of Tank Number Df Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance /IV=Violation Y=Yes N=NO Inspector: Office of Environmental Services (805) 326-3979 Business Site Responsible Party White - Env. Svcs. Pink - Business Copy