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3200 f st. bp 1-16-14
KERN BUSINESS FORMS - (661) 325 -5818 - #6013 :BAKERSFIELD .-FIRE,. DEPTaP Prevenxion Services ' E_R S,F I L_D UNIFIED PROGRAM IN'Sh"ECTIO'N:.C`:HEC"KLIST B 2101H Street FrRF ARTM T B" ki ` fii ld, CA" 93301,= SECTION: ''I BllSll'1�$S °PIc'�I'1 at7Ci 'II'1V�Iltd P.ro ral11 326 -39 "79 ry Fax:. "(661).852,:2171 F.'ACILITY NAME : 1NSP /ECTION� DATE INSPECTION TIME , ADDRESS '// PHONE NO., NO OF EMPLOYEES:'— FACILITY"CONTACT BUSINESS ID "NUMBER 1 " Consent to inspect Name /Title f 3 , rqn n , Nil ,. T -� .,,..,,.: r. w.: ,. : , :. � 4 J A ars PIi'0 z a ti sr4P_xJa J ., � y, � _,... „ X `� ;'r,.0 rev .>✓. -,., ROUTINE COMBINED ❑ JOINT:AGENCY ❑ MULTI=AGENCY ❑ COMP LAINT ❑' RE= INSPECTION C. ` V c= Compliance O P'E RAY I O N" COMMENTS. V= Violation ❑ APPROPRIATE PERMIT ON, HAND; `. (BMC: 1,5.65.080) " F0; L7�72 %U. � %ham ❑ B'USIn2SS , PLAN CONTACT INFORMATION,ACCURATE (C.CR: 2729:1) ❑ VISIBLE ADDRESS (CFC: 505.1., BMC: 15.52.020) El CORRECT OCCUPANCY (CBC:'401) rte" . ❑ ` ' VERIFICATION OF INVENTORY MATERIALS (CCR: 2729:3) x. CCR:. 2729:4) , ❑ VERIFICATION OF�QUANTITIES � � ( ❑ VERIFICATION.OF.LOCATIONu (CCR. 2729.2) [ ❑ ` PROPER: SEGREGATION" OFIaAATERIAL (CFC 2704:1) ❑ ' VERIFICATION'.O,F MSDS�VAIL- ABILITY (CCR: '2729.2(3)(b)) ❑ VERIFICATION: OF HAZ "MAT TRAINING (CCR:'2732) ❑ ' `VERIFICATION OF ABATEMENT SUPPLIES & PROCED.URES (CCR. 2731;(c))- A. ❑ EMERGENCY PROCEbURESADEQUATE (CCR: 2731,) ❑ ❑, ' ' CONTAINERS PROPERLY LABELS (CCR: 66262,:34(f), CFC;. 2703.5) ❑ HOUSEKEEPING (CFC: 304.1) FIRE PROTECTION CFC:_903 &906) " SITE .DIAGRAM ADEQUATE & ON HAND, :. (C.CR:,2729:2)� "' mss"` r- ANY 'HAZARDOUS V11.AST:E ON SITE? ❑ YES NO SinatureofReceipt Explain; POST INSPECTION INSTRUCTIONS: ® Correct the violation(s) noted above -by Signature (that;all violations have been corrected" as noted) 11aN,Q „� rnrrn'rtinu nil of the violations, sign and return :a copy of this page.to:: _