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HomeMy WebLinkAbout2010 HAZMAT IIIIIIIIVIIIIIIIIII 61 IE _ Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST B B R 3 D 900Truxtun Ave., Suite 210 -- — RE Bakersfield, CA 93301 SECTION 1 : Business Plan and Inventory Program *AFRI FN 11 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME NSPECTION ATE INSPECTION TIME 6:00 2=^1 ADDRESS PHONE NO. NO OF EMPLOYEES 3 :/L�l, vr9 &W CA .33z) 331 -13`Z. FACILITY CONTACT BUSINESS ID NUMBER K 15-021- �: -� - ,� S®ct o 1-. Business Pla anel-Inventory Pr gra , _ ���� ❑ ROUTINE YL COMBINED ❑ JOINT AGENCY ❑ MULTI-AGENCY ❑ COMPLAINT ❑ RE-INSPECTION C v ( C=Compliance OPERATION COMMENTS V=Violation ❑ X APPROPRIATE PERMIT ON HAND 7- ❑ Business PLAN CONTACT INFORMATION ACCURATE /-' ❑ VISIBLE ADDRESS x ❑ CORRECT OCCUPANCY ❑ VERIFICATION OF INVENTORY MATERIALS ❑ VERIFICATION OF QUANTITIES X ❑ VERIFICATION OF LOCATION ❑ PROPER SEGREGATION OF MATERIAL ❑ VERIFICATION OF MSDS AVAILABILITY p C d A�l s ❑ VERIFICATION OF HAZ MAT TRAINING ❑ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES X ❑ EMERGENCY PROCEDURES ADEQUATE ❑ ❑ CONTAINERS PROPERLY LABELED ❑ HOUSEKEEPING �Z6e°iiOl��6x TS�s� i 7f C 6� J� "Mr ❑ FIRE PROTECTION �(fF,Ldiic J� /VIDSO✓r f7�( �i %� CJl�S�i��� X ❑ SITE DIAGRAM ADEQUATE&ON HAND KBF-6013 ANY HAZARDOUS WASTE ON SITE? ❑YES JKNO EXPLAIN: IIIIIII VIII III IIII 62 I IE QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention/ f'In I Shift of Site/Station#' Business Site Responsible Party(Please Print) White-Prevention Services Yellow-Station Copy Pink-Business Copy FD 2155 (Rev.09/05 Prevention Services UNI-FIED.'PROGRAM INSPECTION CHECKLIST.; B F R S F , 0 900 Truxtun Ave., Suite 210 FIRE Bakersfield, CA 93301 SECTION 1 : Business Plan and Inventory Program "RT"' Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME INSPECTION ATE INSPECTION TIME ADDRESS HONE NO. O OF EMPLOYEES 3 9S- :N �� !cam/ C�4 933a g 33/ -l732 FACILITY CONTACT BUSINESS ID NUMBER G-A 15-021- "Section 1 Busme'ss`P an and !M n o.� Program q rY 9 ❑ ROUTINE COMBINED ❑ JOINT AGENCY ❑ MULTI-AGENCY ❑ COMPLAINT ❑ RE,-INSPECTION ' C V (.c=compliance OPERATION COMMENTS V=Violation 1 ❑ APPROPRIATE PERMIT ON HAND ❑ Business PLAN CONTACT INFORMATION ACCURATE XI ❑ VISIBLE ADDRESS ❑ CORRECT OCCUPANCY ❑ VERIFICATION OF INVENTORY MATERIALS ❑ VERIFICATION OF QUANTITIES X ❑ VERIFICATION OF LOCATION �^ ' X, ❑ PROPER SEGREGATION OF MATERIAL ❑ VERIFICATION OF MSDS AVAILABILITY vv t - Oti sf ❑ VERIFICATION OF HAZ MAT TRAINING ❑ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ❑ EMERGENCY PROCEDURES ADEQUATE ❑ ❑ CONTAINERS PROPERLY LABELED IVIA ❑_ HOUSEKEEPING riJ2 `CC CA61-2 ^ ❑ FIRE PROTECTION IU��%� 'I- /W O OV7- 7`AA-6' Cxl�N J tJ` SLi r ❑ SITE DIAGRAM ADEQUATE&ON HAND _ KBF-6013 ANY HAZARDOUS WASTE'ON SITE? ❑YES �NO EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 NiV Z E C.0--6,59 Inspector (Please Print) Fire Prevention/1a In/Shift of Site/Station# Business Site/Responsible Party(Please Print) rti White-Prevention Services Yellow-Station Copy Pink-Business Copy t FD 2155 (Rev.09/05 -1 .. ._ �; . ,x � � `�. . -' Y .�• � � iq� � C � , f y,� - � _ - BMMRSFIELD FIRE DEPT. INSPECTIONS Prevention Services B E R S F I L D 900 Truxtun Ave., Ste. 210 MR` = B FIR USINESS PLAN & = ART Bakersfield,6 ) 32693979 INVENTORY PROGRAM l Fax: (661) 852-2171 UNIFIED PROGRAM INSPECTION CHECKLIST Page 1 of 1 ,;$'h mil/ S7`�7;pr✓ FACILITY NAME: 6 i;�c' o'er INSPECTION DATE: 32K6; 05 '�--/ cA 9 335 Section 2: Underground Storage Tanks Program ❑ Routine Combined ❑ Joint Agency ❑ Multi-Agency ❑ Complaint ❑ Re-Inspection Type)T(ank Number of Tanks Type of Monitoring Type of Piping OPERATION C V COMMENTS Proper tank data on file Proper owner I operator data on file Permit fees current Certification of Financial Responsibility o7— Monitoring record adequate and current S x— Maintenance records adequate and current Failure to correct prior UST violations x 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 placardingllabeling Is tank used to dispense MVF?) If yes,does tank have overfill!overspill protection? C=Compliance V=Violation Y=Yes N=No Inspector: Business Site Responsible Party Questions regarding this inspection? Please call us at(661)326-3979 White—Prevention Services Pink-Business Copy KBF-7335 FD 2156(Rev.09105) UNIFIED PROGRAM INSPECTION CHECKLIST Prevention Services B E R s F , 0 900 ZYuxtun Ave., Suite 210 - FiRE Bakersfield, CA 93301 SECTION 1 : Business Plan and Inventory Program ARrx Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME INSPECTION DATE INSPECTION TIME shr�// o/V 0,,q ADDRESS PHONE NO. NO OF EMPLOYEES FACILITY CONTACT BUSINESS ID NUMBER ti LC 15-021- ._ and n�entory Proram S®ction 1. 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PLEASE CALL US AT (661) 326-3979 Inspect-or (Please Print) Fire Prevention/1"In/Shift of Site/Station# Business Site/Responsible Party(Please Print) White—Prevention Services Yellow-Station Copy Pink—Business Copy FD 2155 (Rev.09/05 UNIFIED PROGRAM INSPECTION CHECKLIST Prevention Services . e H R 6 P 1 0 900 Truxtun Ave., Suite 210 FIRE Bakersfield, CA 93301 SECTION 1 : Business Plan and Inventory r t{ "RrM Tel.: (661) 326-3979 ry ram C Fax: (661) 872-2171 FACILITY NAME INSPECTION DATE INSPECTION TIME ADDRESS ,3 NO. / O OF EMPLOYEES 3 .� FACILITY CONTACT BUSINESS ID NUMBER hc�/ 15-021- .fif ?�' - $ectlon1 Bwsnness Plan and Inventory Program T k ti . _ ❑ ROUTINE ❑ COMBINED' ❑ JOINT AGENCY ❑ MULTI-AGENCY ❑ COMPLAINT ❑ RE-INSPECTION C v ( C=Compliance OPERATION COMMENTS V=Violation ❑ ❑ APPROPRIATE PERMIT ON HAND ❑ ), Business PLAN CONTACT INFORMATION ACCURATEb,ev-�S ❑ VISIBLE ADDRESS ❑ CORRECT OCCUPANCY ❑ VERIFICATION OF INVENTORY MATERIALS ❑ VERIFICATION OF QUANTITIES Jdl ❑ VERIFICATION OF LOCATION ❑ PROPER SEGREGATION OF MATERIAL ❑ ❑ VERIFICATION OF MSDS AVAILABILITY ❑ VERIFICATION OF HAZ MAT TRAINING ❑ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ❑ EMERGENCY PROCEDURES ADEQUATEf��JS ❑ Cl CONTAINERS PROPERLY LABELED PA ❑ HOUSEKEEPING �iti1UVF -�N S, p GO/2 6 .r' N 2ih !—/Zes�6 ❑ FIRE PROTECTION NLC`C� 1_7011N7''_ ❑ SITE DIAGRAM ADEQUATE&ON HAND KBF-6013 ANY HAZARDOUS WASTE ON SITE? ❑YES KNO EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL.US AT (661) 326-3979 Inspector (Please Print) Fire Prevention/1"In/Shift of Site/Station# Business Site/Responsible Party(Please Print)' White—Prevention Services Yellow-Station Copy Pink—Business Copy FD 2155 (Rev.09105 , �, s, . - _ ,� ��� ,: ,. � �' ._ �. � • "� .� -fir '` l Prevention Services UNIFIED PRO-GRAM INSPECTION CHECKLIST B e R s F t D 900 Truxtun Ave., Suite 210 F irE Bakersfield, CA 93301 SECTION 1 : Business Plan,and Inventory Program AArx T Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME INSPECTION DATE INSPECTION TIME ADDRESS _ PHONE NO. 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PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention/ f In I Shift of Site/Station# Business Site/Responsible Party(Please Print) White—Prevention Services Yellow-Station Copy Pink—Business Copy '; FD 2155 (Rev.09/05