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1107 CALLOWAY DRIVE
Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST 4 I, in 900 Truxtun Ave., Suite 210 - Bakersfield, CA 93301 Tel.: (661) 326 -3979 SECTION 1: Business Plan and Inventory Program � Fax: (661) 872 -2171 FACILITY NAME INSPEC ION DATE INSPECTION TIME COMMENTS V= Violation ADDRESS PHONE NO. `/ O OF EMPLOYEES Q O 1 FACILITY CONTACT BUSINESS ID NUMBER 15 -021- Section 1: Business Plan and. Inventory Program ❑ ROUTINE ❑ COMBINED ❑ JOINT AGENCY ❑ MULTI - AGENCY ❑ COMPLAINT ❑ RE- INSPECTION C v ( C= Compliance OPERATION COMMENTS V= Violation ❑ APPROPRIATE PERMIT ON HAND iQ9 ❑ Business PLAN CONTACT INFORMATION ACCURATE /fit ❑ VISIBLE ADDRESS ❑ CORRECT OCCUPANCY 4 ❑ VERIFICATION OF INVENTORY MATERIALS bQ ❑ VERIFICATION OF QUANTITIES ❑ VERIFICATION OF LOCATION ©� ❑ PROPER SEGREGATION OF MATERIAL L�p 13 VERIFICATION OF MSDS AVAILABILITY I ❑ VERIFICATION OF HAZ MAT TRAINING '❑ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES C ❑ EMERGENCY PROCEDURES ADEQUATE ❑ CONTAINERS PROPERLY LABELED c� 'S�- ❑ HOUSEKEEPING ❑ / FIRE PROTECTION ❑ SITE DIAGRAM ADEQUATE & ON HAND nnr -outs ANY HAZARDOUS WASTE ON SITE? tO-YES ❑ NO EXPLAIN: A.s n w a.._. Q(, a -- QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326 -3979 Inspector (Please Print) Fire Prevention / 1" In / Shift of Site /Station # �usiness Site White — Prevention Services Yellow - Station Copy Pink — Business Copy FD 2155 (Rev. 09/05 I Prevention Services UNIFIED PROGRAM INSPECTION CHECKLIST) n x a.._Rs_F t.. e _...._0 900 Truxtun Ave., Suite 210 - - -_ - -- - - - - -. — - - - - - - - _ - — - -- _- FIRE Bakersfield, CA 93301 SECTION 1: Business Plan and Inventory Program �II� AR TM , r Tel.: (661) 326 -3979 U Fax: (661) 872 -2171 FACILITY NAME INSPECTION DATE INSPECTION TIME COMMENTS EC J ( l) (c, APPROPRIATE PERMIT ON HAND ADDRESS PHONE NO. NO OF EMPLOYEES i I U c i�11 -5CJ ? FACILITY CONTACT BUSINESS ID NUMBER 15 -021- Section 1=: Business Plan and Inventory Program ❑ ROUTINE ❑ COMBINED ❑ JOINT AGENCY ❑ MULTI - AGENCY ❑ COMPLAINT ❑ RE- INSPECTION C V c C= Compliance OPERATION V= Violation COMMENTS C00 ❑ APPROPRIATE PERMIT ON HAND ❑- ❑ Business PLAN CONTACT INFORMATION ACCURATE e Ell ' ❑ VISIBLE ADDRESS c ❑` ❑ CORRECT OCCUPANCY C'O ❑ VERIFICATION OF INVENTORY MATERIALS 130 ❑ VERIFICATION OF QUANTITIES Q) ❑ VERIFICATION OF LOCATION '0::=l ❑ PROPER SEGREGATION OF MATERIAL 0,) ❑ VERIFICATION OF MSDS AVAILABILITY ❑ ❑ VERIFICATION OF HAZ MAT TRAINING 0� ❑ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ❑� ❑ EMERGENCY PROCEDURES ADEQUATE ❑ CONTAINERS PROPERLY LABELED Y . c n E1,- ❑ HOUSEKEEPING �0:,, ❑ FIRE PROTECTION / L . -3,G'-- .9 , O,,, ❑ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ❑ YES ❑ NO EXPLAIN: X w r -_ ,or -: ; \ QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326 -3979 Inspector (Please Print) Fire Prevention / 1" 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