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FACILITY NAME ,
NSPECTION DATE
INSPECTION TIME
A71 25
ADDRESS
HONE NO.
O OF EMPLOYEES
17
FACILITY CONTACT
BUSINESS ID NUMBER
Consent to Inspect Name/Title.,-
Section 1. Business P11an and Irrenitt r
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D•o ROUTINE ❑ COMBINED ❑ JOINT AGENCY El MULTI -AGENCY ❑ COMPLAINT ❑ RE -INSPECTION
omp lance
OPERATION"'
CERS
V =Violation; 111 Minor
Violation
E N T
ACTIVE HAZARDOUS MATERIALS PERMIT (BMC 15 65.080)
3010001
6ERS INFORMATION ENTERED &PDATED ANNUALLY (CPR: 2729.1)
1010008
VISIBLE ADDRESS(CFC: 505.1, BMC: 15.52.020)
CORRECT OCCUPANCY (CBC: 401)
ins
VERIFICATION' OF INVENTORY MATERIALS (CCR: 2729,3)
1010004
x,
k
VERIFICATION OF QUANTITIES (CCR: 2729.4)
1010006
`V
VERIFICATION OF LOCATION (CCR: 2729,2)
Q
PROPER SEGREGATION OF MATERIAL (CFC: 2704.1)
VERIFICATION 2729.2(3)(b))
OF SDS AVAILABILITY (CCR:
VERIFICATION OF HAZ MAT TRAINING (CCR: 2732)
1020002
Q,
.ell
VERIFICATION' OF ABATEMENT SUPPLIES & PROCEDURES (CCR: 2731(c))
EMERGENCY PROCEDURES ADEQUATE (OCR: 2731)
1010010
re
CONTAINERS PROPERLY LABELED (CCR: 66262,34(f), CFC: 2703.5)
3030007
HOUSEKEEPING (CFC; 304.1 }
FIRE PROTECTION ,- (CFC: 903 & 906)
3030032
y
SITE DIAGRAM ADEQUATE & ON HAND (CCR: 2729.2)
1010005
x
A�,
A. NY HAZARDOUS WASTE ON SITE? CT YES ❑ NO
i mature of R.eeei
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x p 1 a i n: <7
Inspector. �x ' 7 ,.t
F
3.
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POST INSP &ION INSTRUCTIONS:
1
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• Correct the violations) noted above by.—
• Within 5 days of correcting all of the violations, sign and return a copy of this page to:
Balser: -field Fire Dept., Prevention Services, 21.01 H Street, California 93301
White — Business Copy Yellow -- Station Copy Pint. -- Prevention Services
Signature (that all violations have been corrected as noted)
Date
FD2155 (.Rev 6l2021)