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FACILITY NAME
INSPECTION DATE
INSPECTION TIME
V= Violation; 1,11 Minor
Violation
COMMENT
ADDRESS
PHONE NO.
NO OF EMPLOYEES
3010001
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BUSINESS PLAN CONTACT INFORMATION ACCURATE (CR:
2729.1)
BUSINESS ID NUMBER
FACILITY CONTACT
'
Consent to Inspect Name/Title
C: 15.52.020)
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❑ ROUTINE ❑ COMBINED ❑ JOINTAGENCY MULTI - AGENCY ❑ COMPLAINT ❑ RE- INSPECTION
C V C= Compliance OPERATION
CERS
V= Violation; 1,11 Minor
Violation
COMMENT
APPROPRIATE PERMIT ON HAND ,,:'(BM
:15.65.080)x,:
3010001
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BUSINESS PLAN CONTACT INFORMATION ACCURATE (CR:
2729.1)
1010008
'
VISIBLE ADDRESS (CFC: 505.1, B
C: 15.52.020)
i
CORRECT OCCUPANCY
(CBC:401)
VERIFICATION OF INVENTORY MATERIALS
CCR: 2729.3)
1010004
VMERIFICATION OF QUANTITIES
CCR: 2729.4)
1010006
VERIFICATION OF LOCATION
CCR: 2729.2)
f..
PROPER SEGREGATION OF MATERIAL
CFC: 2704.1)
VERIFICATION OF SDS AVAILABILITY (CCR:
729.2(3)(b))
VERIFICATION OF HAZ MAT TRAINING
(CCR: 2732)
1020002
VERIFICATION OF ABATEMENT SUPPLIES & PROCEDURES (CCR:
2731(c))
EMERGENCY PROCEDURES ADEQUATE
(CCR: 2731)
1010010
<3
CONTAINERS PROPERLY LABELED (CCR: 66262.34(%
CFC: 2703.5)
3030007
HOUSEKEEPING
(CFC: 304.1)
t 1 }fir
µ. BC
C4
FIRE`:PROTECTION (CFC:
903 & 906)
3030032
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SITE DIAGRAM ADEQUATE & ON HAND
CCR: 2729.2)
1010005
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ANY HAZARDOUS WASTE ON SITE? 'AYES ❑ NO
Signature ofRecei`t „ a
Explain :
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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
Date
White Business Copy Yellow — Station Copy Pink Prevention Services FD2155 (Rev 8//14)