HomeMy WebLinkAbout2021_10_19 Sams Club_ Minor ViolationUNIFIED PROGRAM INSPECTION CHECKLIST
Underground Storage Tank Program
i BAKERSFIELD FIRE DEPARTMENT
Prevention Services Division
H F r F 1 L T) 2101 H Street
�/RE Bakersfield, CA 93301
ARTM T
Phone: 661-326-3979
Fax: 661-852-2171
NOTICE TO COMPLY /SUMMARY OF VIOLATIONS
MINOR VIOLATIONS
Owner/Operator:
Facility: ' Alt q� L-) 11- &W -
Address: 5 rr C-) a. P -1�nI - I , r 1cl�; S <1
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There were NO violations observed during this 6spection.
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Notice to Comply: Minor Violations were found during this inspection as noted in the following
Summary of Violations.
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The violations indicated in this inspection report must be corrected within 30 days, unless
otherwise noted.
Formal enforcement may be initiated for any violations noted, and for those not corrected in a
timely manner. This report does not represent that there are no other violations at this facility. A
re -inspection may occur to determine compliance status.
SUMMARY OF VIOLATIONS
Item
#
REQUIREMENT FOR CORRECTION OF DATE FOR
VIOLATION VIOLATION CORRECTION
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Inspectors
Si nature:
g
Received by:
[Phone:
Print Name:
Date:
Date:
CERTIFICATION OF RETURN TO COMPLIANCE
I certify that the violations noted above on this Notice to Comply/Summary of Violations have been
corrected. I have personally examined any documentation attached to the certification to establish that
the violations have been corrected.
[Signature:
[Title:
[Print Name:
Date:
KPS #8446
White — Business Copy Yellow — Business Copy to be sent in after Return -to -Compliance Pink — Prevention Services Copy