HomeMy WebLinkAbout2302 COLUMBUS STREET_HMBP_MT VERNON DENTISTRY 3.9.11UNIFIED PROGRAM INSPECTION CHECKLIST
SECTION 1: Business Plan and Inventory Program
Prevention Services
J�AR R S F I o 900 Truxtun Ave., Suite 210
/RE Bakersfield, CA 93301
TM r Tel.: (661) 326 -3979
Fax: (661) 872 -2171
FACILITY NAME
INSPECTION DATE
INSPECTION TIME
ADDRESS
23aL CaW vv, (3jS S�
PHONE NO.
7 -IllI1
NO OF E PLO ES
FACILITY CONTACT IE7
BUSINESS ID NUMBER
15 -021
Section 1: Business Plan and Inventory Program
OUTINE ❑ COMBINED ❑ JOINT AGENCY ❑ MULTI - AGENCY ❑ COMPLAINT ❑ RE- INSPECTION
C v c 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
❑ VERIFICATION OF LOCATION
❑ PROPER SEGREGATION OF MATERIAL
❑ 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
CW4", 1%-6
Inspector (Please Print) Fire Prevention / 1s' In / Shift of Site /Station #
White — Prevention Services Yellow - Station Copy Pink — Business Copy FD 2155 (Rev. 09/05