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Tel.: 661 32 3 7
SECTION 1 . 8ushess Plan and Inventory Pro'ram y � ( > 6 9 9
.Fax: (661) 852-2171
FACILITY NAME INSPECTION DATE INSPECTION TIME
ADDRESS' PHONE NO.t NO'OF EMPLOYEES
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FACILITY CONTACT BU81NESS ID NUMBER
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Consent to Inspect Name/Title
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Qu �nes Phan andnyentor: Pro. :ram
U'' ROUTI N E
.' ❑ COMBINED � ',JOINT AGENCY � .: ❑ ..MULTI-AGENCY- ❑ COMPLAINT. . "" ❑ RE-INSPECTION.
C-Compliance
C V ( ) OPERATION. COMMENTS
V=Violation
❑��' ❑ AP°1-""PRIATE PERMIT ON HAND (BMC: 1.65.080)
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BUSINESS PLAN CONTACT INFORMATION',ACCURATE (CCR:2729.1)
``' ❑
VISIBLE ADDRESS (CFC:5:Q5.1,BMC: 15.52.020)
:> ❑x" ❑ CORRECT OCCUPANCY (CBC-401)
'' ❑ VERIFICATION OF INVENTORY MATERIALS
(CCR:2729.3) : •
_r D VERIFICATION OF QUANTITIES (CCR:2729.4)
3
'. VERIFICATION OF LOCATION (CCR 2729.2)
❑ PROPER SEGREGATION OF MATERIAL (CCR:2704.1)
D El VERIFICATION OF M
SDS AVAILABILITY
(CCR:2729.2(3)(8).)
i
j'. ❑ VERIFICATION OF HAZ MAT TRAINING (CCR:2732)
❑. VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES (CCR:2.7.31)) '
177 I
'' ❑ EMERGENCY PROCEDURES ADEQUATE .
. � � (CCR:2731)
❑. CONTAINERS PROPERLY LABELED (CCR:66262.34(F),CFC 2703.5)
: I
HOUSEKEEPING (CFC:304.1)
❑ ❑ FIRE PROTECTION (CFC:903.&906)
El 1771 SITE DIAGRAM ADEQUATE&ON HAND (CCR:2729.2)
ANY HAZARDOUS WASTE O
A N SITE?
❑YES C N O Signature of ReceiptM
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Explain
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POST INSPECTION INSTRUCTIONS: i• :
• Refer to the back of this ins ecton re ort for regulatory ulat
p p g Y Y e actions
or citations an correctev
• Correct the violation(s)noted.above by Signature(that all violations have been corrected s noted)
Within,5 days of correcting all of the violations,sign and return.a copy of this page to: �
Bakersfield Fire Dept. Prevention Services-,2101.H Street,California°93301
Date
to he hite—Business Copy Yellow--Bu iness Copy in after."return to Com liance Pi Prevention Services Co FD2155( )
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