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UNIFIED PROGRAM INSPECTION CHECKLIST
SECTION 1: Business Plan and Inventory Program
Prevention Services
B E R S F I o 900 Truxtun Ave., Suite 210
*FIRE Bakersfield, CA 93301
ARrN rN r Tel.: (661) 326 -3979
Fax: (661) 872 -2171
FACILITY NAM
INSPECTION DATE
INSPECTION TIME
r_- -
4 `Ill
ADDRESS
%
PHONE NO.
NO OF EMPLOYEES
c d 4 s ci LV
z
FACILITY CONTACT
U (NESS NUMBER �/
15- 021
T6 09 M 4 5 �
- 000 2-q
Section 1: Business Plan EffinventcIrR.Ennearganm
ROUTINE ❑ 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
Oil ❑ HOUSEKEEPING
1C^, e- C f
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❑ FIRE PROTECTION
2" ❑ SITE DIAGRAM ADEQUATE & ON HAND
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ANY HAZARDOUS WASTE ON SITE? R YES ❑ NO
EXPLAIN: tk 1 5T6 61L
QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326 -3979
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Inspector (Please Print) Fire Prevention / 1�' In / Shift of Site /Station # B ess i e�R sponsible Pa -rty (Plea-e )
White - Prevention Services Yellow - Station Copy Pink - Business Copy FD 2155 (Rev. 09/05