HomeMy WebLinkAboutinspection report 2016BAKERSFIELD FIRE DEPARTMENT
Prevention Services Division
Underground Storage Tank Program 2101 H Street
DW Inspection Report �° Bakersfield, CA 93301
Permission to Inspect: Phone: 661 - 326 -3979
,r. Fax: 661 -852 -2171
Business Name: SULLY'S CHEVRON -15- 021 - 72659- Service Station Holdings
Date: 11/17/2016
Address Name: 6009 Coffee Rd- CAL000336148
Inspector Name: Shane Gardner #8248557
Inspection Type: Routine
I Report: Final
NVO = No Violation Observed OUT = Out of Compliance NA = Not Applicable UD = Undetermined
COS = Corrected On Site RPT = Repeat Violation
Violation
Program Requirement
d o
SOC
Comments
No
>
Q
o
O a
a`�o
Z
O
Z
M
0
re
p j
File Review
Facility Tank Information
2030021
Facility has a valid Permit
Tank 1- 12000- DW -REG
to Operate from the
Tank 2- 12000- DW -PRM
CUPA - 23 CCR 16 2712(1);
®
❑
❑
❑
❑
❑
None
Tank 3- 12000- DW -DSL
HSC 6.7 25284
Tank 4-
2010010
UST Operating Permit
Application for Facility
information and Tank
information
®
❑
❑
❑
F]
❑
None
submitted /maintained - 23
CCR 16 2711; HSC 6.7
25286(a)
2010001
Current BOE number
submitted to the CUPA
®
❑
❑
❑
❑
❑
None
and /or CERS - HSC 6.7
25286(c)
2030011
UST compliance
statement and /or
Designated Operator
❑
❑
❑
❑
❑
None
current certification
submitted - 23 CCR 16
2715(a), 2715(b)
2030046
A complete and accurate
response plan has been
submitted, approved and
®
❑
❑
❑
❑
❑
None
maintained - 23 CCR 16
2632, 2634(e), 2641(h),
2712(i)
2030041
A complete and accurate
plot plan has been
submitted, approved and
®
❑
❑
❑
❑
❑
Minor
maintained - 23 CCR 16
2632 d (1 )(C , 2711(a)(8)
2010006
Owner /Operator has not
made false statements or
representation on any
®
❑
❑
❑
❑
❑
None
required document - HSC
6.7 25299
2010003
Owner /Operator has a
DO and /or informed the
CUPA of any change (s)
®
❑
❑
❑
❑
❑
None
within 30 days - 23 CCR
16 2715(a)
1
Violation
Program Requirement
4-
0
0.0
SOC
Comments
No
a
(1)
0
*0
42 cc
1
z
1
0
1
z
M
Testing
2030002
Owner/Operator has
tested and certified leak
Z
None
detection equipment
annually - 23 CCR 16 2638
2030048
Secondary containment
testing conducted every
36 months in accordance
Z
None
with requirements - 23
CCR 16 2637
2030055
Spill buckets have been
tested annually as
❑
❑
❑
❑
❑
None
required - HSC 6.7 25284.2
2010009
Secondary containment
test results submitted to
the CUPA within 30 days
None
after the test - 23 CCR 16
2637(e)
2030064
CUPA was poperly
notified within the
prescribed number of
Z
None
hours prior to testing - 23
CCR 16 2637(1), 2638(e),
2643(g), 2644.1(a)(4)
Install/Repair
2060009
Permits obtained to
install, replace, repair, or
Z
F]
El
r_1
El
E]
None
modify part of the US�
System - 23 CCR 16 2712
1
1
UST System Observation
General Monitoring
2030003
Leak detection system
maintains continuous
RD
monitoring that activates
Z
❑
❑
1:1
❑
❑
None
[:1
an audible and visual
Yes
alarm - 23 CCR 16 2632,
2634, 2636, 2666
2030016
The annular space of the
tank, piping and sumps
RD
are continuously
monitored and activates
Z
❑
❑
1:1
❑
❑
None
Z
the alarm - 23 CCR 16
Yes
2631(g), 2632(c)(2)(A)&(8),
2633(c), 2636(o
2030017
Product piping outside the
UDC is fail-safe and shuts
down the pump or
ED
❑
❑
❑
❑
❑
None
restricts flow - 23 CCR 16
2636(0 (5)
2030018
Turbine sump monitor
activates an audible and
RD
visual alarm or stops the
❑
❑
❑
❑
None
❑
flow of at the dispenser -
Yes
23 CCR 16 26360(1)
Underground Storage Tank Program - DW Inspection Report v 2.0
Violation
Program Requirement
46 C
2 0.
SOC
Comments
No
a
CO
0
0.
z
0
z
:D
0
W
>
2030019
Monitoring system in the
UDCs activates an
audible and visual alarm
❑
❑
❑
❑
❑
None
or stops the flow at the
UDC -23 CCR 16
2636 (0(1)
2030043
Leak detection equipment
DSL STP SUMP
properly programmed or
RD
properly operated - 23
❑
❑
❑
❑
❑
None
CCR 16 2632, 2634, 2636,
Yes
2666
2060005
System constructed with
a monitoring system
capable of detecting entry
E
❑
None
into secondary
containment - HSC 6.7
25291 (b)
2060014
Correct leak detection
equipment installed for
RD
the type of system
None
[-I
present - 23 CCR 16 2638,
Yes
HSC 6.7 25290.1, 25290.2,
25291
2060015
Sensor located in the
RD
proper position/location -
None
❑
23 CCR 16 2630(d), 2641(a)
Yes
2030062
Facility is in compliance
with not tampering with or
RD
disabling leak detection
None
❑
devices or alarms - HSC
Yes
6.7 25299(a)(9)
2060022
System constructed with
a monitoring system
capable of detecting entry
None
into secondary
containment - HSC 6.7
25290.2(d)
2030034
Tag/sticker on affixed
monitoring equipment
being certified, repaired,
1:1
❑
❑
None
or replaced - 23 CCR 16
638(o
VPH Monitoring VPH
2030065
Interstitial monitoring of
the annular spaces of the
RD
UST is properly
❑
❑
1:1
F-1
None
❑
maintained - HSC 6.7
Yes
25290.1 (e
2060023
System constructed with
a monitoring system
capable of detecting entry
into secondary
1:1
❑
r-1
None
containment - HSC 6.7
25290.1(d)
Underground Storage Tank Program - DW Inspection Report v 2.0
Violation
Program Requirement
4-
0 0 .0
SOC
Comments
No
M
a
0
CL
W
42 cc
0
Z
0
Z
M
0
W
Line Leak
Detector
2060012
Line leak detector
installed on pressurized
RD
piping system - HSC 6.7
0
nMn[:)n
None
El
25290. 1(h), 25290.2(g),
Yes
25291(g, 25292(e),
2636(1) (2)
2030026
Line leak detectors detect
a 3 gph leak and/or
RD
audible and visual alarm
E
❑
❑
❑
❑
❑
None
F-1
function properly - 23
Yes
CCR 16 2636(0(6),
2666(c)
2030027
Turbine shuts down when
a leak is detected or
RD
when line leak detector is
❑
None
F-1
disconnected - 23 CCR 16
Yes
2666(c)
2030025
Pressurized piping able to
detect a 3.0 gph leak
RD
wijthin an hour, and
❑
F-1
❑
❑
r-1
None
❑
restricts the flow or
Yes
alarms - 23 CCR 16
2636(0(2)
Secondary Containment
2060010
UST storing a hazardous
RD
substance has secondary
❑
None
F-1
containment - HSC 6.7
Yes
25292
Underground Storage Tank Program - DW Inspection Report v 2.0
Violation
Program Requirement
4-
0
SOC
Comments
No
0:;�.
D
C)
Co
0
a .
00
Z
0
Z
M
0
W
2030008
UDC, sumps, and/or
other secondary
containment in good
None
condition and/or are free
of debris/liquid - HSC 6.7
25290.1, 25290.2, 25291
2030040
Secondarily contained
RD
piping maintained to allow
E
E:]
E]
E]
r--j
None
1:1
liquid to drain into sump -
Yes
23 CCR 16 2630(d), 2641 (a)
2060006
Secondary containment
piping slopes back to the
None
collection sump - 23 CCR
16 263(g)
2030047
Secondary containment
maintained tight and has
been confirmed by testing
[D
❑
❑
❑
❑
❑
None
- 23 CCR 16 2662, HSC 6.7
25290.1(c)(2), 25290.2(c)(2),
25291(a), 25292(e)
2030060
Entry fittings in secondary
containment for UST
system maintained
None
tight/sealed - 23 CCR 16
2630, 2635(d), 2636(c),
2666
2060020
Spill bucket is installed
and has a functional drain
RP
valve or other means to
❑
❑
❑
None
❑
remove liquid - 23 CCR 16
Yes
2635(b), 2665
2030054
Spill bucket maintained in
RP
good condition and free of
None
❑
debris and/or liquid - 23
Yes
CCR 16 2635(b), 2715(c)(2)
2060019
Spill bucket to has a
minimum capacity of five
E
❑
❑
F-1
❑
F-I
None
gallons - 23 CCR 16
2635(b), 2665
Overfill
2030035
UST system is operated
to prevent unauthorized
RP
release, including spills
None
❑
and overfills - HSC 6.7
Yes
25292.1 (a)
2030036
Overfill prevention system
has not been overridden
RP
and meets overfill
E
❑
❑
❑
1:1
❑
None
❑
requirements - 23 CCR 16
Yes
2635(b)(2)! 2665
1
1
Underground Storage Tank Program - DW Inspection Report v 2.0
Violation
Program Requirement
0
0.0
S O-C
Comments
No
10
'.
:)
4
Q
0
40
120 cc
Q)o
z
1 A-
0
---I
z
On Site
Records
Certifications
2030023
Required designated
operators or contractors
maintain a proper and
0
❑
❑
None
current ICC certification -
23 CCR 16 2715
2030024
Service technician,
installer, and/ or
employee maintain a
❑
❑
None
proper license - 23 CCR
162715
2030031
Employee or contractor
obtained and maintained
proper manufacturer
E
❑
❑
F-1
❑
❑
None
certification - 23 CCR 16
2715
2010007
Submit/maintain current
Certificate of Financial
Responsibility /mechanism
of financial assurance -
❑
FIE]
❑
None
23 CCR 16 2711; 23 CCR
18 2808.1, 2809-2809.2;
HSC 6.7 25292.2; HSC
6.75 25299.30-25299.34
Designated Operator
2010004
Copies of DO inspections
for last 12 months and list
of trained employees
0
❑
❑
❑
❑
❑
None
maintained - 23 CCR 16
2715
2030013
Designated operator
properly conducted the
monthly inspection and
None
the reports are complete -
23 CCR 16 2715
2030010
DO notified operator of
any condition observed
during the monthly
E
❑
❑
❑
❑
❑
None
inspection that may
require action - 23 CCR 16
2715 d
2030012
DO employee training
performed, current for at
least one employee on
0
F-1
❑
❑
❑
❑
None
site, and a log kept - 23
CCR 16 2715(c)(6), 2715(1)
Underground Storage Tank Program - DW Inspection Report v 2.0
Violation
Program Requirement
4-
0
SOC
Comments
No
Q
0
42
01• °-
Z
0
Z
>
Logs
2030001
Leak detection alarm
logs, maintenance and
RD
records of appropriate
ED
1:1
❑
❑
❑
❑
None
❑
follow-up actions
Yes
maintained - 23 CCR 16
2632, 2634, 2712(b)
Maintenance/Tests
2010008
Monitoring, maintenance,
repairs, linings, and
RD
upgrade records
0
❑
❑
None
❑
maintained for the proper
Yes
time period - 23 CCR 16
2712(b)
Documentation
2030033
Failure to maintain on site
an approved monitoring
None
plan - 23 CCR 16 2632,
2634, 2711, 2712(1)
2030037
Written agreement
between the tank owner
and tank operator to
monitor the tank system
None
is maintained - 23 CCR 16
2620(b); HSC 6.7
25284(a)(3)
2030061
Suspected or actual
unauthorized release
RD
reported in appropriate
None
❑
time frame - HSC 6.7
Yes
29294,29295
General Operating Requirements
Permit Condition/Approval
2030039
Compliance with all
operating permit
❑
❑
❑
None
conditions - 23 CCR 16
2712; HSC 6.7 25299
2030059
UST system maintained
in accordance with
exclusion/exemption
None
status - HSC 6.7 25281.6,
25283.5
2030014
Owner/Operator received
approval and has
implemented a training
None
program at an unstaffed
facility - 23 CCR 16
2715(0(2)
2030015
Facility exhibited that the
method used to monitor
the tank meets the
monitoring methods in
❑
❑
❑
❑
❑
None
2643(f) - 23 CCR 16 2643
Underground Storage Tank Program - DW Inspection Report v 2.0
Violation
Program Requirement
d o
SOC
Comments
No
05-
a
Q
ILU
0
0.
00
z
0
z
n
0
W
in
Red Tag
2030045
Red Tag information is
legible and has not been
❑
❑
S
❑
❑
❑
None
tampered with - 23 CCR
16 2717.1(
2030044
Facility did not allow for
deposit of petroleum into
a UST that has a red tag
❑
❑
Z
❑
❑
❑
None
affixed to the fill - 23 CCR
162717.1(0
Install/Repair
2060024
UST system is made of or
lined with materials that
are compatible with the
❑
❑
❑
❑
❑
None
substance stored - 23
CCR 16 2631.1
2060021
Striker plate installed and
positioned correctly - 23
Z
None
CCR 16 2631(c), 2662(d) I
I
I
❑ There were no violations noted for this inspection.
ZThis report shall serve as a "NOTICE TO COMPLY" for Minor Violations, and a "NOTICE OF VIOLATION" for
Major violations. You are, hereby, ordered to correct the above noted violations within 30 days, or according to
correction summaries provided. Formal enforcement and/or penalty assessment may be initiated for any
violations noted, and for those not corrected in a timely manner. (NOTE: If this is a preliminary report, a final report
will follow.)
Inspectors Signature: Date:
Inspector: Enter # of Violations: RD: -*' RP: C:)
Check one box for facility Significant Operational Status (SOC) to be reported to SWRCB and US EPA:
F-1 SOC with both Release Detection and Release Detection (Facility has no Release Prevention and no Release
Prevention Violations)
❑ Not in SOC (Facility has both Release Prevention and Release Detection Violations)
❑SOC with Release Detection only (Facility has no Release Detection violations but one or more Release Prevention
violations)
JE]-SOC with Release Prevention only (Facility has no Release Prevention violations but one or more Release Detection
violations)
Underground Storage Tank Program - DW Inspection Report v 2.0
FACILITY NAME
CERS
INSPECTION DATE
INSPECTION TIME
Violation
COMMENT
ADDRESS
PHONE NO.
NO OF EMPLOYEES
3010001
FACILITY CONTACT
1010008 .
BUSINESS ID NUMBER
Consent to Inspect Name/Title
VISIBLE ADDRESS (CFC: 505.1, BMC: 15.52.020)
. ..:,... - c �. .C' ^,df *ia F;r a�
.,.,, M1.. u ..:x x e >x. ..,<.! k 3...:k tYti. �:. ,...:,`;r ,.. ......: . �,.. :� 3srsa' 5. .. .,,. �.
h M.: '.: 4. i. 'Ce...''Y: .F i; .k... Sf„ •Q,. x... i...:. .4 >. ,iW ✓..y ,.. ..: .§
£�. , S ,, x.. .k 4 v ... a. zt? �. .. 4'. ,. 7.t
, .4 :.Y: k+i .,f 1 xT .`1. IN
. urn.. i . �. >f Y X 3c. fi... .,. > ri. .. tw 'i :. .,,cy,.. i < M :. W✓ x z ^.. r.... v „ ..t� -.. �' ♦. .. uu, 83 F
a, `',.. �». - ._. .:.. '?. .<. '�.... �':: -,.. 1., `a,t�., 4.. a... .,. .,... .. �a � :�.F.n ....di, k.., s,, .. .:. .�s
.A.,.... � a .,:..:,.. � ., �.., s. x�.. .... ... , s �..,... � ..:tom .....
,. >.. . 3. -..4 s.. :. ,`?. � ,a.. ..a -f c- -,}.' ,a r . sy .3,
. >. ,r. .4. r , F. z. v .. : .mow -.... ,. c �'�,a.. :. .� ,.. .. ,::�,.., .i'. ,. .e
:. ... <r ms, � ,v v '�.. X e:. ? ��,1 vY .. 5.... .7.,,- ..sa s� `uC. v... '<. .... �..,r
sk- ... ,c- 'r..,.m. �. .. . .2..1`. ,nzr M, �<. � ss �... ^.,,�.. c U.a .,z�, ,3w.:.
rf' „x... ✓' ;3 3s". v . 'a..'�k. ..v � x. a. ,. sT a .- b.. a . ,
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`
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v 1- x' 1. n3., n . .F ' :�... .!'s., os# �� .sL...'.�'u. 'vw�'r ,".�. ., :✓
�' Zr, °��,lr`.�`"a'4'n' "� w f ssSi�u�'.` �,. z��:S,.:k�s;'�b�,:�,sz.+6os�;.: ,<f c,: [>. a�SK. a„ a' �:# f. r• A.-.. �..:' uc�.r.,�; <e:cYF��,kr<"xr:, «f�a, x�w:r<ksF�,.,.. �'..ra..".m z. �,. s' re, r,. r. Y, w�u, s.. awa..: e.»-: zt�. �,{, c:,:.::' Q' �r�' rr ,xi :��.°'Zwx3.��..:..,�,.�:.,,.
❑ ROUTINE ^,COMBINED ❑ 'JOINT AGENCY ❑MULTI - AGENCY ❑COMPLAINT ❑ RE-
INSPECTION
G V C= Compliance OPERATION
CERS
v =Violation; 1,11 Minor
Violation
COMMENT
APPROPRIATE PERMIT ON HAND (BMC:15.65.080)
3010001
BUSINESS PLAN CONTACT INFORMATION ACCURATE (CCR: 2729.1)
1010008 .
VISIBLE ADDRESS (CFC: 505.1, BMC: 15.52.020)
CORRECT OCCUPANCY (CBC: 401)
VERIFICATION OF INVENTORY MATERIALS (CCR: 2729.3)
1010004
VERIFICATION OF QUANTITIES (CCR: 2729.4)
1010006
VERIFICATION, OF LOCATION (CCR: 2729.2)
PROPER SEGREGATION OF MATERIAL (CFC: 2704.1)
VERIFICATION OF SDS AVAILABILITY (CCR: 2729.2(3)(b))
VERIFICATION OF HAZ MAT TRAINING (CCR: 2732)
1020002
VERIFICATION OF ABATEMENT SUPPLIES & PROCEDURES (CCR: 2731(c))
EMERGENCY PROCEDURES ADEQUATE (CCR: 2731)
1010010
CONTAINERS PROPERLY LABELED (CCR: 66262.34(f), CFC: 2703.5)
3030007
HOUSEKEEPING (CFC: 304.1)
FIRE PROTECTION (CFC: 903 & 906)
3030032
SITE DIAGRAM ADEQUATE & ON HAND (CCR: 2729.2)
1010005
NY HAZARDOUS WASTE ON SITE? ❑ YES � NO Sign atureafReceipt
Explain;. f
Inspector• --
POST INSPECTION INSTRUCTIONS:
• Correct the violation(s) noted above by
• Within 5 days of correcting all of the violations, sign and return a copy of this page to: Signature (that all violations have been corrected as noted)
Bakersfield Fire Dept., Prevention Services, 2101 H Street, California 93301,,i:
Date
White - Business Copy Yellow — Station Copy Pink — Prevention Services FD2155 (Rev 8H14)
Owner/Operator: < raj j c <-:z-7 A ~7 j3
Facility: - "' 176 0
Address: o ' 0 ,; C 'r P..
SUMMARY OF VIOLATIONS
Item R
Notice Of Violation Clans H nd /or Class I Violations were found during this inspection as
noted in the followm mmary of Violations.
REQUIREMENT FOR CORRECTION D
The violations indicated in this inspection report must be corrected within.30 days, unless.,
4t',+"' �
otherwise noted.
��+iE pPp
Formal enforcement will be initiated for all Class I Violations, and for any Class 11 violations not
corrected within` the required timeframe.' This report does not represent that there are no other
"F i r .0 9� � " 6+ _ 4'..3
violations at this facility.. A re- inspection may occur to determine compliance status
SUMMARY OF VIOLATIONS
Item R
VIOLATION
REQUIREMENT FOR CORRECTION D
DATE FOR
4t',+"' �
�yy c� ,r� f � �
��+iE pPp
I `^"' { F %".�.. 4 S.
i1 J Li `L"; C3' A5 9 J) - "
"F i r .0 9� � " 6+ _ 4'..3
(P �`' i
White — Business Copy Yellow — Business Copy to be sent in after Return -to- Compliance Pink - Prevention Services Copy
HAZARDOUS WASTE BAKERSFIELD FIRE DEPARTMENT
UNIFIED PROGRAM CONSOLIDATED FORMS- A Prevention Services
I 14E R S F I D 2101 H Street
SMALL QUANTITY HAZARDOUS piss Bakersfield.. CA 93301
WASTE GENERATOR INSPECT-ION ARM Phone: 661-326-3979 • Fax: 661-852-2171
Facility Name: V _SL L i :-? Date: //7 /7 -
_71
Site Address: Time In: Time Out:
Owner/Operator: 0 1 LLIZ(d
" - Phone: EPA ID O 3
V /,)
Type of Inspection
0 Routine 0 Re-inspection/Follow-up ombined Routine Inspection 0 Joint Inspection 0 Complaint 0 Focused 0 Other
0 CONSENT TO INSPECT GRANTED Y (Name / Title):
Inspection may involve obtaining photographs, review and copying-'of records,: and 6fi nation of compliance with hazardous waste handling requirements.
C 1
V I
HAZARDOUS WASTE REQUIREMENT
NIA
CERS
Violation #
COMMENTS
Recordkeeping/documentation -
yj
I
Generator has an EPA ID number [HSC 25143.131
3010002
Hazardous waste determination made for all wastes
0 Analysis *Generator Knowledge [CCR 66262.40]
3030005
>c
Contingency plan information posted near phone _[CCR 66262.34(d)(2)]
3010022
114
?
Facility personnel demonstrate training/awareness _ [CCR 66262.34(d)(2)]
3020001
Manifests/Consolidated Manifest receipts complete [CCR 66262.23(a)]
3010008
Blue co (s) of manifest mailed to DTSC [CCR 66262.23(a)(4))
3010011
Bills of Lading/receipts available [CCR 66262.40(a)]
3010010
LDRs available and cqM2lete (CCR 66268.7(a)]
3030006
Onsite recycling reported using UPCF [HSC 25143. 101
3030001
Container/tank management
Containers are in good condition [CCR 66262.34(d)(2)]
3030013
Containers are closed except when adding/removing.[CCR66262.34(d)(2)]
3030017
Satellite containers at or near point of generation [CCR 66262.34(e)(1)(A)l
Empty containers are empty [CCR 66262.34(f)]
3030007
Containers inspected weekly [CCR 66262.34(d)(2)]
3030019
Tanks inspected daily [CCR 66262.34(d)(2),40CFR 265.2011
3030027
One container per waste` stream at satellite area [CCR 66262.34(d)(2)]
3030022
Exclude recyclable materials stored in accordance with local
ordinance/hazardous materials codes [HSC 25143. 10]
3010016
Accumulation Time Limits
Waste is accumulated not more than 90 270- [CCR 66262.34(d)]
3030010
Empty containers managed within one year [CCR 66262.34(d)]
3030010
Universal waste accumulated less than one year [CCR 66273.15(a)]
3030011
Used oil filters offsite within 180 Q year <1 ton) [CCR 66266.130(c)(4)]
3030004
Pb-acid batteries offsite within 180 (1 yr. < I ton) [CCR66266.81(a)(3)]
3030002
Labeling/Marking
—Yep
Containers are properly labeled [66262.34(f)]
3030007
Excluded recyclable materials marked properly [HSC 25143.9(a)]
3050005
Universal waste container properly labeled (CCR 66273.341
3030008
Used oil filters marked "drained used oil filters" [CCR 66266.130]
3030004
Date written on spent lead-acid batteries [CCR 66266.81(a)(6 (B)]
1 3030003
"Used Oil" marked on all used oil tanks/containers [CCR 66279.21(b))
3030007
Tank marked with "haz waste" , contents, start date [66262.34(f)]
3030007
Treatment, Transport and Disposal/Other
Have permit/authorization to do treatment [HSC 25136.2]
3040003
Waste sent with authorized transport (gen. eligible) [CCR 66263.41)
3050001
Waste disposed of to authorized point/p art y [HSC 25189.5(a)]
3050002
Failed to properly handle appliance wastes f-11-MC25212(a))
Fire Protection [66262.34(d)(2)]
3030032
Print and sign In this box for receipt of this report. Signature does not imply agreement with findings only receipt of report.
INSPECTOR
POST INSPECTION INSTRUCTIONS:
• Correct the violation(s) noted above by
• Within 5 days of correcting all of the violations, sip and return a copy of this page to:
Bakersfield Fire Dept., Prevention Services, 2101 H St. Bakersfield, CA 93301
White — Business Copy Yellow— Station Copy
Signature (that all violations have been corrected as noted)
Date
FD2171 (Rev 9/14)
Pink- Prevention Services Copy