HomeMy WebLinkAbout2000 PHYSICIANS PLAZA BoulevardUNIFIED PROGRAM INSPECTION CHECKLIST,
SECTION 1: Business Plan and Inventory Program
Prevention Services
900 Truxtun Ave., Suite 210
FIRE Bakersfield, CA 93301
ARrM r Tel.: (661) 326 -3979
Fax: (661) 872 -2171
FACILITY NAME
INSP TION ATE
INSPECTION TIME
_t<ms s E� c NEti"4-E
36 a
❑
ADDRESS
PHONE NO.
NO OF EMPLOYEES
aZ� � c. Armes �'eZq 1
❑
❑
FACILITY CONTACT t
BUSINESS ID NUMBER
15 -021-
C
V
Section 1: Business Plan and Inventory Program
❑ ROUTINE
❑
COMBINED ❑ JOINT AGENCY ❑ MULTI - AGENCY ❑ COMPLAINT
❑ RE- INSPECTION
C
V
C= Compliance OPERATION
V= Violation
COMMENTS
❑
❑
APPROPRIATE PERMIT ON HAND
❑
❑
Business PLAN CONTACT INFORMATION ACCURATE
❑
❑
VISIBLE ADDRESS
❑
❑
CORRECT OCCUPANCY
L
❑
❑
VERIFICATION OF INVENTORY MATERIALS
❑
❑
VERIFICATION OF QUANTITIES
❑
❑
VERIFICATION OF LOCATION
❑
❑
PROPER SEGREGATION OF MATERIAL
❑
❑
VERIFICATION OF MSDS AVAILABILITY
\
v
❑
❑
VERIFICATION OF HAZ MAT TRAINING
❑
❑
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? ❑ YES ❑ NO
EXPLAIN:
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326 -3979
Inspector (Please Print) Fire Prevention / 151 In / Shift of Site /Station #
Business Site / Responsible Party (Please Print)
�OY-OVIJ
White — Prevention Services Yellow - Station Copy Pink — Business Copy FD 2155 (Rev. 09/05
Prevention Services
UNIFIED PROGRAM INSPECTION CHECKLIST A E R s F. 0 900TruxtunAve., Suite 210
-- ---- -- - --- - - --
FIRE Bakersfield, -CA 93301
SECTION 1: Business Plan and Inventory Program '" ° ARTM t Tel.: (661) 326 -3979
Fax: (661) 872 -2171
FACILITY NAME
INSSPEF TION ATE
INSPECTION TIME
1 -- e- 7
600110
❑
ADDRESS
PHONE NO.
NO OF EMPLOYEES
pbd t C_,Ar -c
❑
❑
FACILITY CONTACT
BUSINESS ID NUMBER
15 -021-
i -
;' � _ uslnes Pla "an d=Inven�tory Pr_ograrng
Sectlon,1 B
s3 a@w e :.k wk• i� ..
❑ ROUTINE ❑ COMBINED ❑ JOINT AGENCY ❑ MULTI - AGENCY ❑ COMPLAINT ❑ RE- INSPECTION
C.
v
( C= Compliance OPERATION
V= Violation
COMMENTS
❑
❑
APPROPRIATE PERMIT ON HAND
❑
❑
Business PLAN CONTACT INFORMATION ACCURATE
❑
❑
VISIBLE ADDRESS
❑
❑
CORRECT OCCUPANCY
❑
❑
VERIFICATION OF INVENTORY MATERIALS
\
❑
❑
VERIFICATION OF QUANTITIES
r�
❑
❑
VERIFICATION OF LOCATION
❑
❑
PROPER SEGREGATION OF MATERIAL
Q!
❑
❑
VERIFICATION OF MSDS AVAILABILITY
❑
❑
VERIFICATION OF HAZ MAT TRAINING
❑
❑
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? ❑ YES ❑ NO
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. 09/05
Prevention Services
UNIFIED PROGRAM INSPECTION CHECKLIST! B K E R S F I-E o 900TruxtunAve., Suite 210
----- -___ -- ------ -__ - -- ._--------------- -___ —I FIRE EV Bakersfield, CA 93301
SECTION 1: Business Plan and Inventory Program °VPP'"RTN ;Nr Tel.: (661) 326 -3979
I� Fax: (661) 872 -2171
FACILITY NAME
INSSP TIONDATE
INSPECTION TIME
COMMENTS
�
❑
V
❑ RE- INSPECTION
❑
ADDRESS
PHONE NO.
NO OF EMPLOYEES
`
❑
BUSIneSS PLAN CONTACT INFORMATION ACCURATE
FACILITY CONTACT
BUSINESS ID NUMBER
❑
15 -021-
C
v
Section 1`: Business Plan and Inventory Program
COMMENTS
❑ 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 ACCURATE
❑
❑
VISIBLE ADDRESS
❑
❑
CORRECT OCCUPANCY
❑
❑
VERIFICATION OF INVENTORY MATERIALS
❑
❑
VERIFICATION OF QUANTITIES
ar N.
❑
❑
VERIFICATION OF LOCATION
❑
❑
PROPER SEGREGATION OF MATERIAL
QN ,
-A
l�
❑
❑
VERIFICATION OF MSDS AVAILABILITY
❑
❑
VERIFICATION OF HAZ MAT TRAINING
❑
❑
VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES
i
❑
❑
EMERGENCY PROCEDURES ADEQUATE
❑
❑
CONTAINERS PROPERLY LABELED
❑
❑
HOUSEKEEPING
❑
❑
FIRE PROTECTION
❑
❑
SITE DIAGRAM ADEQUATE & ON HAND
ANY HAZARDOUS WASTE ON SITE? ❑ YES ❑ NO
EXPLAIN
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326 -3979
Inspector (Please Print) Fire Prevention / P 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
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