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Issued May 24, 1989 <br /> <br />- Pleasanton Fire Department <br /> ~-~-~-~- Railroad Street P.O. Box 520 <br /> Pleasanton, California 94566-0802 <br /> (415) 484-8114 <br /> <br /> Business Name [ .............................................................]Date Due [ ................... ] <br /> <br /> Business Address [ ...............................................................]Pleasanton, California <br /> <br /> Self-Tna~ecfion Worksheet <br /> Directions <br /> · Print your business name and address at the top of this form. <br /> <br /> · You have thirty days to conduct the inspection and complete this form. If you wish <br /> assistance, check the box on page two of this form, or call the fire department at <br /> (415) 484-8114 and ask for Fire Prevention. <br /> <br /> · Walk through your business with this form in hand. Answer all questions listed below. <br /> (Note, spot checks will be conducted by the fire department to determine compliance.) <br /> <br /> · Complete the form by checking (~) the appropriate box '~res", "No", or "na" (not <br /> applicable). If "na" box is checked, give reason in comment section on the form. <br /> <br /> · When the inspection is complete and all corrections * have been made, read, sign, and <br /> date this form and return the original (white copy) to the Pleasanton Fire Department. <br /> <br /> · Correction are indicated if you have answered "no" to any questions 1-8, or "yes" to any <br /> of the remaining questions. <br /> <br /> Yes No n/a Item <br /> <br /> 1. [ ] [ ] [ ] Is your address visible on the outside of your building on contrasting <br /> background, legible from the street serving your building? <br /> <br /> 2. [ ] [ ] [ ] ff you are in a multi-tenant building, is your suite number posted outside <br /> the front door? <br /> <br /> 3. [ ] [ ] [ ] Is the drive or alley around your building kept clear from weeds, debris, or <br /> other fire hazards or obstructions? <br /> <br /> 4. [ ] [ ] [ ] Are all trash containers located at least five feet (5~ from the building? <br /> <br /> 5. [ ] [ ] [ ] Are waste baskets or other waste containers made of metal, or emptied on <br /> a daily basis? <br /> <br /> 6. [ ] [ ] [ ] Is the fire/police/medical emergency telephone number (9-1-1) posted <br /> on or near all telephones? <br /> <br /> 7. [ ] [ ] [ ] Are all exit aisles, hallways, doorways, stairways, landings or walkways <br /> clear of any obstructions? <br /> <br /> If you wish help with this inspection ~/this box [ ], or call 484-8114 Page 1 <br /> <br /> <br />