HomeMy WebLinkAbout2500 WIBLE ROAD (5).,,
UNIFIED PROGRAM INSPECTION CHECKLIST~
~ ~,___~_-_~~.---~-T.=--.._~ --------_-~:r----__ ~.__._.__..__.~.----~---..__=iE
SECTION 1: Business.. Plan and lnventory Program j~
~
~~ ~ Prevention Services
B, F R S ~,_ D 9001Yuxtun Ave., Suite 210
F/RE Bakersfield, CA 93301
D AR~M Tel.: (661) 326-3979
~ ' F~: (661) 872-2171
FACILITY NAME INSPE 10 DATE INSPECTION TIME
i ~~ ~
ADDRESS
(' HON N O OF EMPLOYEES
~O~ ~~
~ ' ~ ~
83 3
FACILITY CONTACT BUSINESS ID NUMBER
15-021-
a
/ . Section 1: Business Plan and Inventory Program
^ ROUTINE OMBINED ^ JOINTAGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION
C V ~ C=Compliance~ OPERATION
V=Violation COMMENTS
^ APPROPRIATE PERMIT ON HAND
^ BUSIfI@SS PLAN CONTACT INFORMATION ACCURATE
^ VISIBLE ADDRESS
M LJ CORRECT OCCUPANCY
^ VERIFICATION OF INVENTORY MATERIALS
^ VERIFICATION OF QUANTITIES
^ VERIFICATION OF LOCATION
^ PROPER SEGREGATION OF MATERIAL
L~ ^ VERIFICATION OF MSDS AVAILABILITY
^ VERIFICATION OF HAZ MAT TRAINING ~
C ~ S
~/Cl VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
^ EMERGENCY PROCEDURES ADEQUATE ~
CONTAINERS PROPERLY LABELED
^ HOUSEKEEPING
^ FIRE PROTECTION
~
^ ^ SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITE?
EXPLAIN:
^ YES ^ lDl~
QUEST-b,~JS REGARpINCy,THIS INSPECTION? PLEASE CALL US AT (661) 326-3979
(Please Print) ~ire Pre4ention / 1" In / Shift of Site/Station #
White - Prevention Services Yellow - Station Copy
~
Busine ite / Responsible Party (Please Print)
Pink - Business Copy
FD 2155 (Rev. 09/OS
FACILITY NAME: ~r~~(~SS
Section 2: Underground Storage Tanks Program
BAKERSFIELD FIRE DEPT.
Preveation Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326-3979
Fax: (661) 852-2171
Page 1 of 1
INSPECTION DATE: 1~1,1j u i
~ Routine ~ Combined ^ Joint Agency ^ Multi-Agency ^ Complaint ^ Re-Inspection
Type of Tank ~_ Number of Tanks ~
Type of Monitoring 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 o
Section 3: Aboveground Storage Tanks Program
Tank Size(s)
Type of Tank
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
Aggregate Capacity
Number of Tanks
Busi s Site Responsible Party
Pink - Business Copy
~~
KBF-7335 FD 2156 (Rev. 09/05)
CORRECTION NOTICE
BAKERSFIELD FIRE DEPARTMENT 0 015 7 2
' PREVENTION SERVICES DIVISION
1600 TRUXTUN AVENUE, SUITE 401
(661) 326-3979
~ocation: ~ ~[`~C~ ~ Q? r ~-~c (~ (1'1~~- ~ '~l~c~l~ c~~
You are hereby required to take the following action at the above location;
uI~:ORRECT & CALL FOR REINSPECTION ^ CORRECT & PROCEED
\ ., ~ _ ~ , ,
~
(~c a~~ t~ c~ R-k~ ~ c t~?
Completion Date for Corrections: 1~ /~_ /~
~
Received by `~^
inspector: Steve Underwood Initial ~_Date: ~.. t /~_ /~_
Desk Phone: (661) 326-3190 (from B:OOam to 8:30am)
KBF-9229
CORRECTION NOTICE
BAKERSFIELD FIRE DEPARTMENT 0 015 7 2
PREVENTION SERVICES DIVISION
1600 TP~JXTUN AVENUE, SUITE 401
~ ° (661) 326-3979
, .~ocation: -~ ~ ~ i~- t ~- ~1~ ~ i' ~' ~- X lx2S ~
,
~c a~c~-~ d ~. R-~-(~ ~~i C~
Completion Date for Corrections: t~ ~~._ ~~
Received by ~ „
inspector: Steve Underwood Initial ~-Date: ~, ~ ~_~ ~~_
Desk Phone: (661) 326-3190 (from 8:OOam to 8:30am)
KBF-9229
You are hereby required to take the following action at the above location;
u1/~;ORRECT & CALL FOR REINSPECTION 0 CORRECT & PROCEED
~ _ ~ . . i 1 _ .
Unidocs - Uniform Documents
~Ia~~ardous ~Ma~er~a{I~ ~Or~lt~~ ~1~~-.ento, 3; ,Pr~ject
Page 1 of 2
Creating a Chemical inventory Form
Modify Existing Chemical Information for DOWTHERM
Chemical information returned by database:
CHEMICAL NAME ' CAS#
ETHYLENE GLYCOL 111-46-6
COMMON NAME
DOWTHERM
FIRE CODE HAZARD CLASSES
COMBUSTIBLE LIQUID, CLASS III-B
IRRITANT
OTHER HEALTH HAZARD
HAZARDOUS MATERIAL TYPE
PURE
FED HAZARD CATEGORIES
FIRE
ACUTE HEALTH
CHRONIC HEALTH
PHYSICAL STATE
LIQUID
STATE WASTE CODE
NONE
DOT HAZARD CLASS EHS'
FLAMMABLE AND COMBUSTIBLE LIQUIDS NO
LOCATION INFORMATION
CHEMICAL LOCATION
Breckenridge Mtn.
.. ..... .... ... ._ .. .. .
Select from Previous Locations '~~c
....._......~ .......... ..... .. .
CONFIDENTIAL EPRCA : MAP # GRID #
NO ~~, , .
-:: ~
II. CHEMICAL INFORMATION
TRADE SECRET ~' Yes ~ No DAYS ON SITE MATERIAL TYPE
365 ~ ,r::~,::
(If subject to EPCRA, refer to instructions) r-~
_____..__~.._.__....~ aste ,~._,
CURIES (enter in millicuries, 1000 mCi = 1 Ci)
~
LARGEST CONTAINER
MAXIMUM DAILY AMOUNT AVERAGE DAILY AMOUNT VOLUME ANNUAL WASTE AMOUNT
110 ` 110 ` 55 ~ 10
UNITS:
Gallons ' =:
3~~::,.
STORAGE CONTAINER (check all that apply)
~ ABOVEGROUND TANK r PLASTIC/NONMETAL DRUM I- FIBER DRUM I- GLASS BOTTLE
~ UNDERGROUND TANK I- CAN I- BAG r PLASTIC BOTTLE
r TANK INSIDE BUILDING I~ CARBOY I- BOX I!: TOTE BIN
Unidocs - Uniform Documents.
~ STEEL DRUM ~W; SILO
~ RAIL CAR ~: OTHER
MANAGEMENT METHOD (required if material fs waste)
~~ SHIPPED OFF-SITE ~' RECYCLED ON-SITE
STORAGE PRESSURE
~! AMBIENT ~ ABOVE AMBIENT
STORAGE TEMPERATURE
r' AMBIENT ~' ABOVE AMBIENT
~-: CYLINDER ~ TANK WAGON
r TREATED ON-SITE
~' BELOW AMBIENT
r BELOW AMBIENT r CRYOGENIC
Page 2 of 2
r~, c."^-. _'".~,.~"`~,..~^-~ ~-tr H x . ~",~'" .,~ ..
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