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3301 wible bp 12-28-11
357392- KERN BUSINESS FORMS — (661) 325 -5818 — #6013 y ':BAKERSFIELD FIRE DEPT. %� T �( '�f ➢ Prevent on. Sere ces NIFIE ®. P:ROGRAIVI 1NS:PE ION "CH °EC \.LrtIST g E :R S',F D 2101 H Street AWRT ► T Bakersfield; CA 93301' S"E �: T' ®N 7 : BUSIt7t'SS PIa11� and lh—ventol - PCOgrarn Tel.: (661) 32 :6 3979 Fa x (661)852 -2171. I " F.ACILITY`NAME INSPECTLCON DATE INSPECTION TIME" ADDRESS. :PHONE NQ NO OF:EMPLOYEES FACILITY`.CONTA"CT BUSINESSID NUMBER: Consent to Inspect Name/Title all o..: ... :a. ..... ':.:• .. ::..2 . ,.. : ,.r., , r. .,a .. ,.. ':.:k x. ." .. ,..: .r ¢, d ,.. ^::`m t ) kx 1 C S ,te � s a.m ❑ .ROUTINE: COMBINED " ❑ :JOINT<AGENCY ❑ MULTI- AGENCY ❑ 'COMP.LAINT' ❑ RE- INSPECTION. . , .. I C= Compliance TS C: V� ( ) OPERATION CO.MM -E� . ' V= Violation, ❑- /APPROPRIATE PERMIT ON HAND (BMC: 15.65.080) ❑ BUSIheSS PLAWCONTACT!INF,ORMATION ACCURATE (OCR: 2729.1) . ❑ VISIBLE ADDRESS ' (CFC ,505. 1, BMC:'.95.52.020)`'" ❑ CORRECT OCCUPANCY" (CBC: 401)" `' . ❑ ", "VERIFICATION OF'INVENTORY MATERIALS � (CGR: 2729.3) i t ❑ VERIFICATION OF`QUANTITIES (CCR: 2729.4),-,,. ❑ VERIFICATION. OF LOCATION (CCR :2729.2) ❑ " PROPERSEGREGATION OF MATERIAL (CFC,: 27.04 1) VERIFICATION OF MSDS AVAILABILITY (CCR: 2729.2(3)(b)) ❑; VERIFICATION OF HAZ MAT, TRAINING (OCR: . ❑ ❑ .VERIFICATION, OF ABATEMENT SUPPLIES &PROCEDURES (CCR: 2731(c)) !, ❑ EMERGENCY PROCEDURES ADEQUATE (CCR.2731) ❑ CONTAINERS PROPERLY LABELED (CCR: 66 "262.34(f), CFC: °.2703 5). HOUSEKEEPING. (CFC:304.1) ;�`€ � 6-lcrf ❑ FIRE- PROTECTION (CFC: 903' &'906) ❑ SITE DIAGRAM`ADEQUATE &'ON HAND (CCR:'2729,.2), ANY HAZAR "DONS. WASTE "ON SIl.E'? ❑ YES ❑ NO Si "fitke of-Receipt' Ex p l'.a.i n POST;INSPECTION ',MTRU,CTIONS: • Correct he violation(s) noted above by Signature (that alliolatioris have beencorrected.as- rioted) • Within:5. days <o "correcting'all ofthe violations, sign:and return a copy ofthis page to: