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KERN- BUSINESS FORMS - 661 325 -5818 #6013
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'Bak rs eld, CA
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Tel (661) :326 -3979:
Fax' (6 61) ":852 217,1'-
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FACILITY NAME
'I,NSRECTION DATE
INSPECTION TI -ME
ADDRESS"`
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PHONE NO
NO OF EMPLOYEES
FACILITY CONTACT < .
BUSINESS ID `.NUMBER
Consent to Ins ect Name7Title-
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❑" ROUTINE COMBINED: ❑ JOINT,AGENCY " „ El MULTI- AGENCY : i� COMPLAINT N . ❑ -. RE= INSPECTION
G V (. C =Comps ante) " OPERATION
G:C7 M "MEN T,
V= Violation
❑. APPROPRIATE PERMIT -ON HAND. (BMC. 15::65.080)
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LQ B.USIn @SS`PLAN CONTACT INFORMATION ACCURATE (CCR:.'2729 1)
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❑ • .. VISIBL'E ADDRESS - (CFC: 505.1, BM 15:52.020)
❑ CORRECTOCCUPANCY . (CBC: 401)
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® ❑ VERIFICATION OF INVENTORY "MATERIALS (CCR: 2729.3)
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❑ - VERIFICATION OF QUANTITIES (CCR: 2729.4)
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❑ - VERIFICATION OF.LOCATION `; (CCR: 2729:2)
❑ PROP,ER SEGREGATION, OF MATERIAL (CFC :2704:1)
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f ❑ ❑ VERIFICATION OF MSDS AVAILABILITY (CCR: 2729.2(3)(b))
1
2732).
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❑ VERIFICATION OF HAZ`MAT:TRAINING (CCR:
b. ". ❑ ' :'VERIFICATION OF ABATEMENT SUPPLIES. &:PRO:CEDURES. (CC
❑ EMERGENCY PROCEDURES ADEQUATE (CCR :-2731)
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❑:. CONTAINERS PROPERLY LABELED (CCR: 66262.r34`(f),.CFC :-2703:5)
(
- CFC 304:1)
❑.. HOUSEKEEPING
CFC 903 & 906)
❑ FIRE PROTECTION (, ..
❑ SITE DIAGRAM.ADEQUATE - &ON "HAND (CCR: 2729'2)
;ANY`:HAZARDOUS" WASTE- O "N SITE? ❑ YES ❑` . "NO
Sinature of Receipt
Explain:
-POST INSPECTION INSTRUCTIONS-
e" Correct the violations) noted above" b"
Signature (thatall violations have been corrected as noted)
.:, rehxrn a copy of this page;to: renoh oWithi„ dxvs of co ns, sign.and