HomeMy WebLinkAbout3601 STOCKDALE HWY (10)UNIFIED PROGRAM INSPECTION CHECKLIST -
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F /RE
D ARTM
SECTION 1: Business Plan and Inventory Program
BAKERSFIELD FIRE DEPT.
Prevention Services
2101 H Street
Bakersfield, CA 93301
Tel.: (661) 326 -3979
Fax: (661) 852 -2171
FACILITY NAME INSPECTION DATE INSPECTION
APPROPRIATE PERMIT ON HAND BMC: 15.65.080)
ADDRESS
Business PLAN CONTACT INFORMATION ACCURATE
PHONE NO.
O%
NO OF EMPLOYEES
FACILITY CONTACT 933,0% BUSINESS ID NUMBER
CORRECT OCCUPANCY
pis- o /-CY 3 3Z
Consent to Inspect Na /Title
VERIFICATION OF INVENTORY MATERIALS CCR: 2729.3)
Ck
ILL VERIFICATION OF QUANTITIES CCR: 2729.4)
Section 1: Business Plan and Inventory Program
ROUTINE COMBINED JOINT AGENCY MULTI - AGENCY COMPLAINT RE- INSPECTION
C V C= Compliance OPERATION
V= Violation
COMMENTS
APPROPRIATE PERMIT ON HAND BMC: 15.65.080)
Business PLAN CONTACT INFORMATION ACCURATE CCR: 2729.1)
VISIBLE ADDRESS (CFC: 505.1, BMC: 15.52.020)
CORRECT OCCUPANCY CBC:401)
VERIFICATION OF INVENTORY MATERIALS CCR: 2729.3)
ILL VERIFICATION OF QUANTITIES CCR: 2729.4)
VERIFICATION OF LOCATION CCR: 2729.2)
PROPER SEGREGATION OF MATERIAL CFC: 2704.1)
VERIFICATION OF MSDS AVAILABILITY CCR: 2729.2(3)(b))
VERIFICATION OF HAZ MAT TRAINING CCR: 2732)
VERIFICATION OF ABATEMENT SUPPLIES & PROCEDURES (CCR: 2731(c))
EMERGENCY PROCEDURES ADEQUATE CCR: 2731)
CONTAINERS PROPERLY LABELED (CCR: 66262.34(f), CFC: 2703.5)Z.e
HOUSEKEEPING CFC: 304.1)
FIRE PROTECTION CFC: 903 & 906)
SITE DIAGRAM ADEQUATE & ON HAND CCR: 2729.2)
ANY HAZARDOUS WASTE ON SITE? l OYES NO Signature of Receipt
Explain:
I sc_—
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:
Bakersfield Fire Dept., Prevention Services, 2101 H Street, California 93301
White - Business Copy Yellow - Business Copy to be Sent in after return to Compliance
Signature (that all violations have been corrected as noted)
Date
Pink — Prevention Services Copy PD2155 (Rev 6H10)
GtV ya S ifs/ Off r4 C' L OCOZ Y 2.33
KERN BUSINESS FORMS — (661) 325 -5818 — 86013
UNIFIED PROGRAM INSPECTION CHECKLIST1 ' 17 R 8V II 8°
c = -- - — — -- — -- —_ — D A R TM
SECTION 1: Business Plan and Inventory. Program
BAKERSFIELD FIRE DEPT.
Prevention Services
2101 H Street
Bakersfield, CA 93301
Tel.: (661) 326 -3979
Fax: (661) 852 -2171
FACILITY NAME INS P %,DATE INSPECTION
APPROPRIATE PERMIT ON HAND
Business PLAN CONTACT INFORMATION ACCURATE
ADDRESS /
G9 2 1/Ci
PHONE NO OF EMPLOYEES
7
FACILITY CONTACT
CORRECT OCCUPANCY
9 -33 0"1 BUSINESS ID NUMBER
VERIFICATION OF INVENTORY MATERIALS CCR: 2729.3)
32
Consent to Inspect 1N' _a\ m ( e /
u
Title
S l i k T-111'Ai C' -0-
Section 1: Business Plan and Inventory Program
ROUTINE COMBINED JOINT AGENCY MULTI - AGENCY COMPLAINT RE- INSPECTION
C v C= Compliance OPERATION
V= Violation
COMMENTS
APPROPRIATE PERMIT ON HAND BMC: 15.65.080)
Business PLAN CONTACT INFORMATION ACCURATE CCR: 2729.1)
VISIBLE ADDRESS (CFC: 505.1, BMC: 15.52.020)
CORRECT OCCUPANCY CBC:401)
VERIFICATION OF INVENTORY MATERIALS CCR: 2729.3)
VERIFICATION OF QUANTITIES CCR: 2729.4)
VERIFICATION OF LOCATION CCR: 2729.2)
r PROPER SEGREGATION OF MATERIAL CFC: 2704.1)
VERIFICATION OF MSDS AVAILABILITY CCR: 2729.2(3)(b))
VERIFICATION OF HAZ MAT TRAINING CCR: 2732)
VERIFICATION OF ABATEMENT SUPPLIES & PROCEDURES (CCR: 2731(c))
EMERGENCY PROCEDURES ADEQUATE CCR: 2731)
CONTAINERS PROPERLY LABELED (CCR: 66262.34(f), CFC: 2703.5) 5TZ—R % 02,7-G' Cf /j /ItG
HOUSEKEEPING CFC: 304.1)
FIRE PROTECTION CFC: 903 & 906)
SITE DIAGRAM ADEQUATE & ON HAND CCR: 2729.2)
ANY HAZARDOUS WASTE ON SITE? ®.YES NO Signature of Receipt
Explain:
A 4
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:
Bakersfield Fire Dept., Prevention Services, 2101 H Street, California 93301
White —Business Copy Yellow— Business Copy to be Sent in atier return to Compliance
Signature (that all violations have been corrected as noted)
Date
Pink — Prevention Services Copy FD2155 (Rev 61/I0)
B E R S P I E L D
FIRE
AIrFM T
Elezl V
FACILITY NAME: _ w&O 2I = y
Section 2: Underground Storage Tanks Program
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326 -3979
Fax: (661) 852 -2171
Page 1 of 1
INSPECTION DATE: . 1,711,
Routine Combined Joint Agency Multi- Agency Complaint Re- Inspection
Type of ank SW Ci Number of Tanks
Type of Monitoring Type of Piping
OPERATION C V COMMENTS
Proper tank data on file
Proper owner / operator data on file
Permit fees current
Certification of Financial Responsibility
Monitoring record adequate and current
Maintenance records adequate and current
Failure to correct prior UST violations
Has there been an unauthorized release? Yes No
Section 3: Aboveground Storage Tanks Program
Tank Size(s)
Type of Tank
Aggregate Capacity
Number of Tanks
OPERATION Y N COMMENTS
SPCC available
SPCC on file with OES
Adequate secondary protection
Proper tank placarding /labeling
Is tank used to dispense MVF ?)
If yes, does tank have overfill / overspill protection?
C = Compliance V z Violation Y = Yes N = No
Inspector: / f1 /Wpl
Questions regarding this inspection? Please call us at (661) 326 -3979
White — Prevention Services
Business Site Responsible Parry
Pink - Business Copy
KBF-7335 FD 2156 (Rev. 09/05)
HAZARDOUS WASTE BAKERSFIELD FIRE DEPARTMENT
UNIFIED PROGRAM CONSOLIDATED FORMS Prevention Services
PINS 1501 Truxtun Ave 1sT FLR
HAZARDOUS WASTE GENERATOR ARrN r Bakersfield, CA 93301
INSPECTION REPORT Phone: 661 - 326 -3979 . Fax: 661 - 852 -2171
Facility Name - 1L,-En2
BBAH' "'
g ZI Date _7 /%
Site Address 3(0 [ STpIL /Cef2 / j l/ / S iL,P' Time In 9; 6V 2-7rime Out
Owner /Operator 1ik Ay`Q ; (( C Phone (,(o! 83y 3Y 93 Misc.
Type of Insp ction Inspection Consolidation EPA ID # t L fLYj4
Routine Re- inspection/Follow -up XCombined Routine Inspection Joint Inspection Complaint Focused Other
Integrated or Multi -Media Inspection CUPA Facility ID#
CONSENT TO INSPECT GRANTED BY (Name/ Title):
Inspection may involve obtaining photographs, review and copying ofrecords, and determination of compliance with hazardous waste handling requirements.
1 -Class I Violation. 11 -Class II Violation. M -Minor Violation Paee of
I 11 M Code HAZARDOUS WASTE REQUIREMENTS Y N N/A COMMENTS /NOTES/DOCUMENT(S) REVIEWED
MISSING INFORMATION/ UNRESOLVED ISSUES
Recordkee in documentation
GRO1 Generator has an EPA ID number
GR02 Hazardous waste determination made for all wastes
Analysis )(Generator Knowledge
GR03 Contin ency plan information posted near phone
GR04 Facility personnel demonstrate training/awareness
GR05 Manifests/Consolidated Manifest receipts complete
GR06 Blue co (s) of manifest mailed to D'I'SC
GR07 TSDF signed copy of manifest available w /in 35
days of waste shipment
GRO8 Bills of Lading/re ei is available
GR09 LDRs available and complete
GRIO Onsite recycling reported using UPCF Svc
Container /tank management
GC01 Containers are in good condition
GCO2 Containers are closed except when adding/removing
GC03 Empty containers are empty
GC04 Containers inspected week)
GC05 Tanks inspected daily
GC06 Satellite containers at or near point of generation
GC07 I Satellite containers under control of operator
GC08 One container per wastestream at satellite area
GC09 Exclude recyclable materials stored in accordance
with local ordinance /hazardous materials codes
Accumulation Time Limits
GA01 Waste is accumulated not more than 90/180/270
GA02 Satellite wastes accumulated for less than I year
GA03 Empty containers managed within one year
GA04 Universal waste accumulated less than one year
GA05 Used oil filters offsite within 180 (l year if <1 ton)
GA06 Pb -acid batteries offsite within 180 I yr. if < I ton)
LabelingtMarking
GL01 Containers are properl labeled
GL02 Satellite containers have 2" ASD inarked once full
GL03 Excluded recyclable materials marked properly
GLO4 Universal waste container properly labeled
GL05 Used oil filters marked "drained used oil filters"
GL06 Date written on spent lead -acid batteries
GL07 Used Oil" marked on all used oil tanks /containers
GL08 Tank marked with "haz waste" , contents, start date
GL09 Empty containers marked with date emptied
Treatment Transport and DisposallOther I Print and sign in this box for receipt of this report. Signature does
not imply agreement with findings, only receip of report. GT01 Have permit/authorization to do treatment
GT02 Waste sent with authorized transport en. eligible)
GD01 Waste disposed of to authorized point/party
GH01 Failed to properly handle appliance wastes
POST INSPECTION INSTRUCTIONS:
Refer to the back of this inspection report for regulatory citations and corrective actions
Correct the violation(s) noted above by Signature (that all violations have been corrected as noted)
Within 5 days of correcting all of the violations, sign and return a copy of this page to:
Bakersfield Fire Dept., Prevention
eric
Services, 1501 Truxtun Avenue, California 93301
r `AJft7 M&1V %eZ
Date
FD2179 (Rev 10/21/08)
White — Prevention Services Copy Yellow— Business Copy
Reiiulatory Citations and Corrective Actions
li
1 1,11 , IRo. : ., . I , I
Description of violation I lie mlatory /statutory citation I Corrective actions to be taken br minor violations marked in the !'M" column our ront)
GR01 The facility failed to obtain an EPA I I) number [Title 22, CCIt, 66262.12] Fora California EPA ID # contact the Department of Toxic Substances Control au
I - 80(1 -618 -6942. For a EPA ID # call 415- 495 -8895. Write the number in the s ace marked TPA ID # " on the front ofthis Page.
GR02 The facility failed to make a waste doernsination for the noted in the
Title 22, CCR, 66262.11 ] Make a determination ofthe waste based on your knowledge (you can use nb/SDS or other docunnentsfor help) or have the waste
sampled and sent to ar state certified laboratory for analysis. Ifsarn ling is conducted tell the lab to anahrze Jar•
GR03 The facility did not have the name and phone number elf the emergency coordinator, the location of fire extinguishers and spill control equipment, or the fire
department telephone number posted nest to the telephone. Title 22, CCR, 66262.34(d)(2)j Prepare and post the above in1bi-matior nest to a prone.
G1204 Facility personnel did not demonstrate that they were familiar with proper waste handling procedures due to
Title 22, CCR, 66262.34(d)(2)j Provide; training to personnel regarding
GIt05 The facility failed to properly complete a hazardous waste manifest. Manifest # was nsissing
title 22, CCR, 66262.23(a)(I )l. Correct the information on the manifest in Box(es) . initial and date. Submita letter to DISC. GISS:; P.O.
Box 806 1'71-1 -I: Sacramento, CA 95812 -0800 staling the ntcnrifest #, the ship dale, pour E /?d /D #. the Box # and correction made andpour signature.
Correction for more than one manifest nutlr be included ill the same letter)
GR66 Facility failed to submit a copy of the manilcsl to DISC within 30 days of shipment. [Title 22, CCR, 66262.32(a)(4)] Alail the blue copv q/l n nifiest
Al to: DTSC, 1'O Box 400, Sacramento. CA 95812 -0401) or a photocopy ol'ihe TSDF cotiv to: DTSC. PO Box 30011, Sacramento. CA 95812
GR07 The facility failed to rile an exception report to DTSC alter not receiving the signed TSDF copy of a manifest within 35 days. ['['tile 22, CCR, 66262.421
Blake a cope o/ the manifest andsemd it with a letter to DTSC. PO Box.- XX, Sacramento, CA 95812 slating what you are doing toJind out wlrn.rou have riot
received the liner/. si necl cool; ol'the manifest. Include a si mature and your limlin s while looking for the manifest in the cover letter.
GR08 The facility tailed (o have copies of receipts for the removal of . [I iSC 25160.2 - Consolidated manil'es(st 66260.81(a)(6)(B)-
lead acid batteries /66266.130- oil filleisl The lacilitv s'Iull contact and request copies of receipts between &
GR09 The facility failed to complete or maintain a Land Disposal Restriction notification for manifest # [['itle 22, CCR, 66262.34(a)(4)1
77te facilitl %shall determine ifits waste is subject to LDK requirements, and il'so, ensure that a LDR ispreparett and submitted with each shipment ol)vasie.
GRID The facility did not submit a recycling report [I -ISC 25143.10] Thefacility- shall complete cold submit the UPCFfarm "Recyclable /Materials Report ". T1he
arm can be loud to www.ca1epa.cq.gqv/pub1 ications/title27/def'au 101till (Ihwfiecyc. pc/J)
GC01 The facility failed to maintain containers holding hazardous waste in good condition. The container of was
fide 22, CCR, 66262.34(a)(I )(A)l The contents of the container of shall imnedialely be nransferred to a container in good condition
6002 The facility failed to keep containel'S Closed Cx CCpI When addlllgh'elll(Willg wattle. The coinainer of was observed open 1, I Ilse 22, CCR,
66262.34(a)(1)(A ) . The lhcilitr shall immediately close all containers and ensure that containers remain closed except when adding or removing waste.
GC'03 The facility is handling contaminated containers as empty when they are not. A container of was noted as not nsccting the definition of
empty. [I'ille 22, C'Clt, 66261.7 The,facilin; shall mark the containeras hazardous waste or consolidate the contents of the container
wily a like waste and imnredicuely label the em tried container with the words "en+ lv "and the date.
GC04 The facility could not demonstrate that containers were being inspected weekly. [Title 22, CCR, 66262.34(a)(1)(A)] Tlre.ficility shall develop rind implement
a plan that ensures that all containers holding waste are ins )ecied weekly
GC'05 The facility could not demonstrate that tanks were being inspected daily. [Title 22, CCR, 66262.34(a)(1)(A) l Thefacility shall keep an log showing that ranks
holding waste are inspected Bail.
GC06 Containers utilizing satellite accumulaion rules were not at or near the point of generation. 1`Tille 22, CCR, 66262.34(e)(I )(A)] Thefiwilirn shall move the
container holding to a location that is at or near the point ofgerreratlon or shall ensure that the waste is removed within 911118111270
dais of first drop of)vasle being acicleel. (if the facilin,,generales less than 100 kg, the clock does not start until 100 k . are generated)
0007 Containers utilizing satellite accumulation rules were not under the control of an operator. [Title 22, CCR, 66262.34(e)(1)(A)l The facility shall ensure that
an o eralor is at or near the point ofaccumu/ation or shall ensure that the waste is removed within 90/18012711 clays of first drop of waste being adcled
GC'08 The facility kept more than one satellite container of at a satellite accumulation area. [Title 22, CCR, 66262.34(e)(I )1 Thefatcilirn
shall imnlecliatelr remove till bill one conlainer from the accumulation area or shall demonstrate that it is not practical or safe to do such.
CIC09 The facility stored exClu(le(I recyclable materials not in accordance with local ordinance /lire code /hazardous materials codes [HSC 25143.9(c)] Thelocili(y
shall return to code by
GA01 The facility accu111rdatCd \ \',Isle for greater than allowed tulle lllnllS (Storage \\'I(h(pr11 a perinil). A container of had an start (late of
marked on it. [Title 22, CCR, 66262.34(a) I The laciliiv shall immnechcaely arrangeliar the removal olfhe waste, and shallsupply a cope of the nuurifest or bill
or la(fing demonstrating removal within days.
GA02 The facility held satellite accumulation wastes for *realer than one vear. 'Title 22, CCR, 66262.34(e)(I )(B) See G.A01 above for corrections.
GA03 The facility failed to properly handle contaminated containers within I vear. ITitle 22, CCR, 66261.7(1)1 See GA01 above fo. corrections.
GA04 The facility held universal wastes for greater than one vear. Title 22, CCR, 66273.15(x) or 66273..35(x) See GA01 above for corrections.
GA05 rile facility held drained used oil filters for greater than 180 days /onc vear. ITitle 22, CCR, 66266.130(c)(4) .See GAM above for corrections.
GA06 The facility held lead acid batteries for greater than 180 days /one vear. 'rifle 22, CCR, 66268.8 1 (a)(6)1 .See GA01 above for corrections.
GLOi The facility failed to properly label all containers. Containers, contents and nsissing inlornsalion are noted on the front of this page. [ °Title 22, CCR,
66262.34(8] Tlhefacilim shall cle(r(v mark all containers with the following: i) the words "Hazardous waste". 2) composition mid physical state. 3) hazard
properly. 4) name and address ol'the generator. and 5) accumulation start date.
GL02 The facility failed to nlak the date the container was moved from the satellite accumulation area [Title 22, CCR, 66262.34(e)(I )(B)l Thefacililr shall mark
all satellite accumulation with the date waste is first added as well as the date the container is fill.
GI-03 The facility failed to mark tanks /container(s) of excluded recyclable materials properly I HSC 25143.9(a)] The ranks /containers of materials shall be clearh,
narked with the words "Excluded recyclable material" instead of "hazardous waste ".
GL04 The facility failed to marl: a container of universal waste properly. [Title 22, CCR, 66273.14 for SQI-I or 66273.34 for LQI-I1. T1heJacili(v shall inonediateiv
marl; all containers holding universal waste with tae words "Universal Waste- "
GL05 The lacility failed to mark a container of drained used oil filters with the words "drained used oil filters ". [Title 22, CCR, 66266.130(c)(3)1 thefutility shall
mark all filter containers with the words „drained used oil filters ".
GI-06 The facility failed to mark the date on which the battery was received. Title 22, CCR, 66266.8 1 (a)(6)(D)l The lac•ilit- shall v nark the dale an each bmterv.
GI-07 The facility failed to mark a lank /container of used oil destined for recycling with the words "used oil" [HSC 25143.9(a)] Clearly nark till larks and
containers with the words "used oil ".
GLOB The facility failed to mark the tank of with the [Title 22, CCR, 66234(f)] TheJhcilit- shrill
cleariv nark the lank with
GI-09 The facility tailed to mark contaminated containers with the (late emptied. Title 22, CCR, 66261.7(8 Clearly mark all containers with the date errr tied.
GI-101 The facility failed to remove front an appliance prior 10 crushing, baling, shredding, sawing or disposing of the appliance [l ISC
25212(a) l. The fctcilit, must submit to DISC an a plicalioh to be certilied as at "Certi /iealA pliance Recrcler"
GT01 The facility failed to obtain a permit or other authorization for treatment of hazardous waste. IDISC 25189.5(d)
GT02 The facility failed to use a registered transporter/Used a transporter or consolidated waste when they were not eligible IFISC 25165(a)/25160
GD01 The facility disposed of hazardous waste at an unauthorized point. 1 -ISC 25189.5(x)
1 1,11 , IRo. : ., . I , I
l
HAZARDOUS WASTE BAKERSFIELD FIRE DEPARTMENT
UNIFIED PROGRAM CONSOLIDATED FORMS Prevention Services
IRS 1501 Truxtun Ave 1ST FLR
HAZARDOUS WASTE GENERATOR D ARM r Bakersfield, CA 93301
INSPECTION ^REPORT Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171
Facility Name / = V! --%/ / /
d /+
Date
Site Address 3(,01 57-/ec 2 /y /7/r/ /G i'% //j / Time Inp, '% Time Out
Owner /Operator V, '- .(,t Ck --' c, VOLT I Phafi %/ 8' 3 /. 3 Misc.
Type of Inspection Inspection Consolidation EPA ID
Routine Re- inspection/Follow -upy Combined Routine Inspection Joint Inspection Complaint Focused Other
Integrated or Multi -Media Inspection CUPA Facility ID#
CONSENT TO INSPECT GRANTED BY (Name/ Title):
Inspection may involve obtaining photographs, review and copying of records, and determination of compliance with hazardous waste handling requirements.
I - Class I Violation, II - Class 11 Violation, M - Minor Violation Paae_ of
I II M Code 11 HAZARDOUS WASTE REQUIREMENTS Y N N/A COMMENTS /NOTES/DOCUMENT(S) REVIEWED
MISSING INFORMATION/ UNRESOLVED ISSUES
Recordkee in documentation
GR01 Generator has an EPA ID number N
GR02 Hazardous waste determination made for all wastes
Anal siK Generator Knowledge A
GR03 Contingency lan information posted near phone
GR04 Facility personnel demonstrate trainin awareness
GR05 Manirests/Consolidated Manifest receipts com lete
GR06 Blue co (s) of manifest mailed to DTSC
GR07 TSDF signed copy of manifest available w /in 35
days ofwaste shipment
GRO8 Bills of Ladin g /recei is available
GR09 LDRs available and complete
GRIO Onsite recycling reported using UPCF f
1 Container /tank mane ement
GC01 Container's are in good condition
GCO2 Containers are closed except when addin removin N
GC03 Empty containers are empty
GC04 Containers inspected weeklyA
GC05 Tanks inspected daily
GC06 Satellite containers at or near point of generation
GC07 I Satellite containers under control of operator 1(
GC08 One container per wastestream at satellite area r
GC09 Exclude recyclable materials stored in accordance
with local ordinancethazardous materials codes
Accumulation Time Limits
GAOI Waste is accumulated not more than 90/180/270
GA02 Satellite wastes accumulated for less than l year
GA03 Empty containers managed within one year X
GA04 Universal waste accumulated less than one year y
GA05 Used oil filters offsite within 180 (1 year if <t ton)
GA06 Pb -acid batteries offsite within 180 l yr. if < 1 ton
Labeling/Marking
GLOI Containers are ro erl labeled
GL02 Satellite containers have 2" ASD marked once full r
GL 03 Excluded recyclable materials marked properly
GL04 Universal waste container properly labeled
GL05 Used oil filters marked "drained used oil filters"
GL06 Date written on spent lead -acid batteries
GL07 Used Oil' marked on all used oil tanks /containers
GL08 Tank marked with "haz waste" , contents, start date
GL09 Empty containers marked with date emptied
Treatment Trans ort and Disposal/Other Print and sign in this box for receipt ofthis report. Signature does
not imply agreement with findings, only receipt ofreport.
0
A{it • C7] U ` -- __.
GTOI Have permit/authorization to do treatment
GT02 Waste sent with authorized transport (en. eligible)
GD01 Waste disposed ofto authorized point/party
GHO1 Failed to properly handle appliance wastes
POST INSPECTION INSTRUCTIONS:
Refer to the back of this inspection report for regulatory citations and corrective actions
Correct the violation(s) noted above by
Within 5 days ofcorrecting all of the violations, sign and return it copy of this page to:
Bakersfield Fire Dept., Prevention Services, 1501 Truxtun Avenue, California 93301
TN5P67c--'EC1I gY ; NfG 111- 1 &D)A/J
Signature (that all violations have been corrected as noted)
Date
While — Prevention ServicesCopy Yellow— Business Copy
FD2179 (Rev 10/21/08)
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