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UNIFIED PROGRAM INSPECTION CHECKLIST
SECTION 1: Business Plan and Inventory Program
Prevention Services
JLAR S F I ___..D 900 Truxtun Ave., Suite 210
RE Bakersfield, CA 93301
TM T Tel.: (661) 326 -3979
Fax: (661) 872 -2171
FACILITY NAME `
INSPECT AN DA
�
INSPE JZ TIME
ADDRESS I ` / /
J
PHQWE N!/ '• '—L/0
NO OF EMPLOYEES
FACILITY CONTACT
BUSINESS ID NUMBER
0 S �� „� L (
15 -021-
Sec ion 1: Business Plan and Inventory Program
MROU11NE ❑ 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 EYNO
EXPLAIN,
QUESTIONS RE ING THIS INSPECTION? PLEASE CALL US AT (661) 326 -3979
Inspector (Please Print) Tire Prevention / 15` In / Shift of Site /Station # Business Site / Responsible Party (Ple Print)
White — Prevention Services Yellow - Station Copy Pink — Business Copy FD 2155 (Rev. 09/05