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HomeMy WebLinkAboutBUSINESS PLAN (2)~~ -- w A a ~y :~ ; .-ji VALLEY DECAL INC SiteID: 015-021-001458 Manager EDWARD J CORRIGAN Location: 3000 N UNION AVE City BAKERSFIELD BusPhone: (661) 327-2041 Map 103 CommHaz Moderate Grid: 20C FacUnits: 1 AOV: CommCode: BFD STA 04 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title EDWARD J CORRIGAN / GENERAL MANAGER RON WALLACE / PRODUCTION MGR Business Phone: (661) 327-2041x Business Phone: (661) 327-2041x 24-Hour Phone (661) 588-3336x 24-Hour Phone (661) 864-1333x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Contact EDWARD J CORRIGAN Phone: (661) 327-2041x MailAddr: 3000 N UNION AVE State: CA City BAKERSFIELD Zip 93305 Owner JANICE LOREE CORRIGAN Phone: (661) 327-2041x Address 3000 N UNION AVE State: CA -- City BAKERSFIELD Zip 93305 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif ' d: RSs : No ParcelNo: Emergency Directives: PROG A - HAZMAT ENr~ J u ~ 2 3 zoo' L. ..- ~, ~~.l.r Yr'n ~..::: , ~ ~ ~~ . ~"=_':'•''':; , ,rc~?rrratrcr!, ! c~ rtifY !!~:::2r' !,~n~lty c I~ ~,~r t~r:~t I h ave ~erscr;~,lly -~:;~ ,r,~-; ~;~;~ ::~„ ?`an;iur ~ti~lth the i^,tcrmaiic~ S re?:'"_F.r 3 ~t~ ' •~;=?[Eu~ the information Is true , ;,i;eurat~, an ; ~ornpia.e. / ~ ~ :ins ~ai E r~`1. ca,tG' -1- 07/16/2007 j. p F VALLEY DECAL INC SiteID: 015-021-001458 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... INDUSTRIAL LACQUER SCREEN WASH RETARD THINNER SOLVENT BLEND SpecHaz~EPA Hazards Frm ~ DailyMax ~Unit~MCP F L 60.00 GAL Mod F ~ L 10.00 GAL Mod F L -5.00 GAL Mod -2- 07/16/2007 ,` '-' -3- 07/16/2007 ;, ,~. F VALLEY DECAL INC SiteID: 015-021-001458 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ P1/'111 R11 R/YT~T TTT TRTI ~ lYTTTl11RT /"ITT T.TT 1RTl 5'1'A'1'E 'TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient METAL CONTAINR-NONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 1.00 GAL 60.00 GAL 1.00 GAL ru~auruu~vva L.vl-1rvlvrlvtJ owt. RS CAS# 36.00 2-Butoxyethanol No 111762 11.00 Aromatic Hydrocarbon No 8030306 9.00 Isopropyl Alcohol No 67630 rlt]L~tiiCL tiJ J~~7 ~J!•1P~1V 1 A TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F / / / Mod ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME SCREEN WASH Days On Site SWC-37 365 Location within this Facility Unit Map: Grid: CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid Mixture Ambient Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 55.00 GAL 10.00 GAL 0.50 GAL ru~uruc.uvvo ~.vrirvlv~ly 1 S owt. Rs cAS# Petroleum Distillate, Heavy Paraffinic, Dewaxed No 8030306 n-Propoxyethanol No 2807309 Diacetone Alcohol No 123422 ntic~riRL L'i. 7.7 ~.7 ~J1~1L~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F / / / Mod -4- 07/16/2007 .;, F VALLEY DECAL INC ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME RETARD THINNER SOLVENT BLEND Location within this Facility Unit STATE TYPE PRESSURE Liquid TMixture~Ambient SiteID: 015-021-001458 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# 78-59-1 TEMPERATURE CONTAINER TYPE Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 5.00 GAL 8.00. GAL t1AGFj1[LVUS l:lJt~lr~lviSlvlJ oWt. ,~ RS CAS# 50.00 Isophorone No 78591 50.00 Benzene No 71432 riAGL-1KL t~~a~~~in~ly 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F / / / Mod -5- 07/16/2007 - -: ~, _ F VALLEY DECAL INC SiteID: 015-021-001458 ~ ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 06/05/2006 ~ 911 Employee Notif./Evacuation 06/05/2006 LET THEM KNOW TO GET OUT. Public Notif./Evacuation 02/27/2007 POSTED EVACUATION SIGNS AT EXITS. Emergency Medical Plan 12/15/1999 MEMORIAL HOSPITAL. -6- 07/16/2007 F VALLEY DECAL INC SiteID: 015-021-001458 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 06/05/2006 ~ SOLVENT CONTAINERS IN 1-GALLON CANS. Release Containment 02/27/2007 20-GAL MRO SPILL KIT. Clean Up 06/05/2006 WIPE WITH PAPER TOWELS AND DRY BEFORE DISPOSING. Other Resource Activation -7- 07/16/2007 i F VALLEY DECAL INC SiteID: 015-021-001458 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~Nc~.iai nac~atu~ Utility Shut-Offs 06/05/2006 A) GAS - NE CRNR OF ALLEY B) ELECTRICAL - NE CRNR OF ALLEY C) WATER - E APPROX MIDDLE OF PROP IN ALLEY D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 11/09/2006 PRIVATE FIRE PROTECTION - EXTINGUISHERS. NEAREST FIRE HYDRANT - ALLEY ACROSS ST. Building Occupancy Level 03/06/2006 6 EMPLOYEES -8- 07/16/2007 _ ;~_ F VALLEY DECAL INC SiteID: 015-021-001458 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 06/05/2006 ~ MSDS SHEETS ON FILE. BRIEF SUNIMARY OF TRAINING PROGRAM: POSTING OF CHARTS. rage Bela ror ruzure use riela zor ruzure use -9- 07/16/2007 e 210 Fax: (661) 872-2171 ` INSPECTION D TE INSPECTION TIME ~ e ~ lsa, PHON NO. 110 OF EMPLOYEES FACILITY CONTACT (BUSINESS ID NUMBER I - ~ 15-021- ®O / ~/ ~~ ':. - -_ __, ` Section 1: Business Plan and Inventory Program. OUTINE ^ COMBINED ^ JOINT AGENCY ^ -MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION i - ~ C V i C=Compliance ( - ) OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HA_ ND ~I ^ BUSIfIeSS PLAN CONTACT INFORMATION ACCURATE ~ ~/ L7 ^ VISIBLE ADDRESS ~- ^ CORRECT OCCUPANCY I ^ VERIFICATION OF INVENTORY MATERIALS L +7 ^ VERIFICATION OF QUANTITIES ~ / L`T ^ VERIFICATION OF LOCATION I ~.,/ L-7 ^ PROPER SEGREGATION OF MATERIAL L7 ^ VERIFICATION OF MSDS AVAILABILITY ~ I LT ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~, { ~ ^ EMERGENCY PROCEDURES ADEQUATE ~~~® Ca` ^ i CONTAINERS PROPERLY LABELED _ -D7 ~ (~ ^ HOUSEKEEPING C~ ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON S1'T/E? YES ^ NO -EXPLAIN: ~/1-ii~`~ [. t:{'/ d,v,~ /111 QUEST17ON~S REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1s' In /Shift of Site/Station # - Busin Sit I esponsible Party ase Print) - White -Prevention Services Yellow -Station Copy - Pink -Business Copy - - FD 2155 (Rev. 09/05 Prevention Services 9 _. E. R S f _~ n 900 Truxtun Ave., Suit FIRE Bakersfield, CA 93301 ~ AR~~ Tel.: (661) 326-3979 :~ ..~ T~ CITY OF BAKERSFIEI.D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAI.1 INSPECTION CHECKLIST w ~~~,~~`~ 1715 Chester Ave., 3'" Floor, Bakersfield, CA 93301 FACILITY NAME U.~u-~`( D~C.g i~ INSPECTION DATE ~_ ~ ' ~ ~ - (7 3 ADDRESS 3006 ~ . u ~IOnI ~ PHONE NO. S Z~ - Zo t-t~ I FACILITY CONTACTS ~~~ ~~ G~~'~'ty~'BUSINESS ID NO. 15-210-Oo/y~~ INSPECTION TIME f ~ t'~'1 ~ n ~ NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program ~outine ^ Combined ^ Joint Agency ^Mtilti-Agency ^ Complaint ^ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping ~~,~ / Fire Protection / ~ ~ : ~ /~ Site Diagram Adequate & On Hand ;j.~~ C,G~ C=Compliance V=Violation r' Any hazardous waste on site?: (_'g'Yes ^ No ~ / Explain: ( C1r^~^,,r!~f~t~', ~~%n~~%r'~ ~~ N~ IA~~S,Lj T Questions regarding this inspection'! Please call us at (661) 326-3979 White - Em. Svcs. Yellow -Station Copy Pink - Business Copy ~~ Busi ite Insp ctor: -- --~ 1 ble -Party UNIFIED~PROGRAM INSPECTION CHECKLIST- ,.,. .SECTION 1: Business Plan and Inventory Program • HARERSFIEIGD FIRE DEPT a Prevention Services ~IiR~ 900 Truxtun Ave., Suite 210 ~R~r Bakersfield. CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME ~~~«. ~ e c L N$PECTION DATE ~Ql ~/~ INSPECTION TIME JO vtn;~~-- ADDRESS 3 000 ~, v~v roti HONE NO. O OF EMPLOYEES FACILITY CONTACT ~QC~ USINESS ID NUMBER 15-021- 06 /y S-g Section 1: Business Plan and Inventory Program ~~ ~`~ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION C V (c=compliance OPERATION v_yiolation COMMENTS ^ APPROPRIATE PERMIT ON HAND . ^ BUSIfI@SS PLAN CONTACT INFORMATION ACCURATE ~~ ^ VISIBLE ADDRESS ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS ^ ! VERIFICATION OF QUANTITIES ~] ^ / VERIFICATION OF LOCATION ~ ^ ^ / PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITY ~ ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND ROCEDURES ~, ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ~. ^ HOUSEKEEPING ^ FIRE PROTECTION ^ ~ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE4 ^ YES ^ NO EXPLAIN: - _ .QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (881) 328-3979 d~ ~( ~-. Inspector (Please Print) Fire Prevention / 1a to / Shitt of Site/Station # White -Prevention Servieae Yellow -Station Copy Pink - Busineae Copy FD2049 (Rev. OZ/OS) ~- -. VALLEY DECAL INC Manager EDWARD J CORRIGAN BusPhone: Location: 3000 N UNION AVE Map 103 City BAKERSFIELD Grid: 20C CommCode: BFD STA 04 SIC Code: EPA Numb: DunnBrad: SiteID: 015-021-001458 (661) 327-2041 CommHaz Moderate FacUnits: 1 AOV: Emergency Contact / Title Emergency Contact / Title , EDWARD J CORRIGAN / GENERAL MANAGER RON WALLACE / PRODUCTION MGR Business Phone: (661) 327-2041x Business Phone: (661) 327-2041x 24-Hour Phone (661) 588-3336x 24-Hour Phone (661) 864-1333x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Contact EDDIE CORRIGAN Phone: (661)' 327-2041x MailAddr: 3000 N UNION AVE State: CA City BAKERSFIELD Zip 93305 Owner JANICE LOREE CORRIGAN Phone: (661) 327-2041x Address 3000 N UNION AVE State: CA City BAKERSFIELD Zip 93305 Period to TotalASTs: = Gal Prepares: TotalUSTs: = Gal Certif ' d: - - -RSs": No ParcelNo: Emergency Directives: PROG A - HAZMAT ;3ased on my inqu'sry of those individuals onsible for obta~rnng the information, t certify s p re under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. ~Ip~ , u C~~ ~" ~ ~~,~~ gnature Date ~ 6 z0a~ -1- 02/20/2007 F VALLEY DECAL INC SiteID: 015-021-001458 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP INDUSTRIAL LACQUER SCREEN WASH RETARD THINNER SOLVENT BLEND F L 60.00 GAL Mod F L 10.00 GAL Mod F L 5.00 GAL Mod -2- 02/20/2007 -3- 02/20/2007 F VALLEY DECAL INC SiteID: 015-021-001458 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME INDUSTRIAL LACQUER Days On Site 365 Location within this Facility Unit Map: Grid: CAS# Liquid TMixtur~Ambient~E ~ AmbientT~E METALOCONTAINRTNONDRUM AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 1.00 GAL 60.00 GAL 1.00 GAL llt~ul]ltiJV V J l~Vl•!r VlV P~lV 1 S %Wt• RS CAS# 36.00 2-Butoxyethanol No 111762 11.00 Aromatic Hydrocarbon No 8030306 9.00 Isopropyl Alcohol No 67630 ruic,ru~L riJ alJJJrlaly 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F / / / Mod ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME SCREEN WASH- Days On Site SWC-37 365 Location within this Facility Unit Map: Grid: CAS# Liquid TMixtur~ Ambient~E ~ AmbientT~E DRUM/BARRELEMETALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 10.00 GAL 0.50 GAL ru~urucLV~o Lvrlrvlvr,1V1J %Wt. RS CAS# Petroleum Distillate, Heavy Paraffinic, Dewaxed No 8030306 n-Propoxyethanol No 2807309 Diacetone Alcohol No 123422 rlti[~t1RL ti J JL~J J1.1L' 1V 1 iJ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F / / / Mod -4- 02/20/2007 F VALLEY DECAL INC SiteID: 015-021-001458 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME RETARD THINNER SOLVENT BLEND Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 78-59-1 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient DRUM/BARREL-METALLI~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 55.00 GAL 5.00 GAL 8.00 GAL I11"1Gt1tCLVUA l.VP7YU1VP,1V 1.7 °sWt . RS CAS# 50.00 Isophorone No 78591 50.00 Benzene No 71432 I1EiGt1CCL H. 7.71:+J.71~11;1V 1 A TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F / / / Mod , -5- 02/20/2007 F VALLEY DECAL INC SiteID: 015-021-001458 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 06/05/2006 ~ 911 Employee Notif./Evacuation LET THEM KNOW TO GET OUT. 06/05/2006 Public Notif./Evacuation POSTED EVACUATION SIGNS AT EXITS. Emergency Medical Plan MEMORIAL HOSPITAL. 12/15/1999 -6- 02/20/2007 F VALLEY DECAL INC SiteID: 015-021-001458 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 06/05/2006 ~ SOLVENT CONTAINERS IN 1-GALLON CANS. Release Containment. 20 GALLONS (~iRO) SPILL KIT. Clean Up WIPE WITH PAPER TOWELS AND DRY BEFORE DISPOSING. 06/05/2006 ~,_ _ V l.i1G1 i\G.7 Vtlt VG Cl\.VIVGLL1Vll -7- 02/20/2007 F VALLEY DECAL INC SiteID: 015-021-001458 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ J~JC l:1Ql AQGQIUA Utility Shut-Offs 06/05/2006 A) GAS - NE CRNR OF ALLEY B) ELECTRICAL - NE CRNR OF ALLEY C) WATER - E APPROX MIDDLE OF PROP IN ALLEY D) SPECIAL - NONE E) LOCK BOX - NO Fire Protec./Avail. Water 11/09/2006 PRIVATE FIRE PROTECTION - EXTINGUISHERS. NEAREST FIRE HYDRANT - ALLEY ACROSS ST. Building Occupancy Level 03/06/2006 6 EMPLOYEES -8- 02/20/2007 y ~.•~, X F VALLEY DECAL INC SiteID: 015-021-001458.E Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 06/05/2006 ~ MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: POSTING OF CHARTS. rage ~ Held for Future Use Held for Future Use --, -9- 02/20/200 + VALLEY DECAL INC ____________________________________ SiteID: 015-021-001458 + Manager BusPhone: (661) 327-2041 Location: 3000 N UNION AYE Map 103 CommHaz Moderate City BAKERSFIELD' Grid: 20C FacUnits: 1 AOV: CommCode: BFD STA 04 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title EDWARD J CORRIGAN / GENERAL MANAGER RON WALLACE / PRODUCTION MGR Business Phone: (661) 327-2041x Business Phone: (661) 327-2041x 24-Hour Phone (661) 588-3336x 24-Hour Phone (661) 864-1333x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Contact =:- --__ _ __ _ _ - _ _- . _ _ -Phone: (661) -327-204-1x- --- ---- MailAddr: 3000 N UNION AVE State: CA City BAKERSFIELD ---- Zip 93305 ~; ,~anice Loree Corrigan ------- Owner _ y, ~ ~:~....r, r, r iLL~x Phone . ( 6 61) 3 2 7 - 2 0 4 lx Address 3000 N UNION AVE State: CA City BAKERSFIELD Zip 93305 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif~d: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT /~`"e~ D~~ ~~ - Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, aQnd complete. Signatur Date -1- 03/06/2006 UNIFIED PROGRAM INSPECTION CHECIfLIST' SECTION ~ 1: Business Plan and inventory Program • ~J e art a ~JItI s FACILITY NAME NSPECTI N ATE INSPECTION TIME ADDRESS ~©00 ~t v ~ ~o.v HONE NO. O OF EMPLOYEES FACILITY CONTACT USINESS ID NUMB j 5~~21 ~ ~ ~ys~ 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 . ^ BUSIf1ASS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS `~ ^ CORRECT OCCUPANCY ^ VERIFICATION OF INVENTORY MATERIALS lfl; ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING ^ VERIFICATION OF ABATEMENT SUPPLIES AND ROCEDURES ( - ^ EMERGENCY PROCEDURES ADEQUATE C~ /, ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING ^ FIRE PROTECTION i ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN YES ^ NO • QUESTIONS REGARDING THIS INSPECTION?[ PLEASE CALL US AT (661) 326-3979 l ~ ~ `i Inspector (Please Print) Fire Prevention / 1" In /Shift of Site/Station # EAKERSFIELD FIRE DEPT Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661) 326-39 9 Fax: (661) 872-21~~ s? OllS White -Prevention Services Yellow -Station Copy Pink -Business Copy FD2049 (Rev. 02105)