Lic 610 Form PDF Details

The Lic 610 form is an important document for businesses in California. This form is used to apply for a license to conduct business in the state. The process of obtaining a business license can be complex, so it is important to understand the requirements and procedures involved. By Famly Law Firm. 2 years ago from FamlyLawFirm's Blog. Licensed by CC BY-NC-ND 4.0) The Lic 610 form is an important document for businesses in California. This form is used to apply for a license to conduct business in the state. The process of obtaining a business license can be complex, so it is important to understand the requirements and procedures involved.

Before you fill out lic 610 form, you will want to know more concerning the type of form you'll work with.

QuestionAnswer
Form NameLic 610 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameslic 610 emergency disaster plan, emergency disaster form, 610 form, lic 610 form

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

EMERGENCY DISASTER PLAN FOR CHILD CARE CENTERS

INSTRUCTIONS:

Post a copy in a prominent location in facility, near telephone.

Licensee is responsible for updating information as required. Return a copy to the licensing office.

NAME OF FACILITY

ADMINISTRATOR OF FACILITY

FACILITY ADDRESS (NUMBER, STREET,

CITY,

STATE,

ZIP CODE)

TELEPHONE NUMBER

( )

I.ASSIGNMENTS DURING AN EMERGENCY (USE REVERSE SIDE IF ADDITIONAL SPACE IS REQUIRED)

 

NAME(S) OF STAFF

TITLE

ASSIGNMENT

 

1.

 

DIRECT EVACUATION AND PERSON COUNT

 

 

 

 

 

 

2.

 

HANDLE FIRST AID

 

 

 

 

 

 

3.

 

TELEPHONE EMERGENCY NUMBERS

 

 

 

 

 

4.

 

TRANSPORTATION

 

 

 

 

 

5.

 

OTHER (DESCRIBE)

 

6.

II.EMERGENCY NAMES AND TELEPHONE NUMBERS (IN ADDITION TO 9-1-1)

POLICE OR SHERIFF

OFFICE OF EMERGENCY SERVICES

RED CROSS

POISON CONTROL

HOSPITAL(S)

OTHER AGENCY/PERSON

CHILD PROTECTIVE SERVICES

III. FACILITY EXIT LOCATIONS (USING A COPY OF THE FACILITY SKETCH [LIC 999] INDICATE EXITS BY NUMBER)

1.

3.

2.

4.

IV. TEMPORARY RELOCATION SITE(S) (IF AVAILABLE, SUBMIT LETTER OF PERMISSION FROM RENTER/LEASSOR/MANAGER/PROPERTY OWNER)

NAME

ADDRESS

TELEPHONE NUMBER

 

 

(

)

NAME

ADDRESS

TELEPHONE NUMBER

 

 

(

)

V.UTILITY SHUT—OFF LOCATIONS (INDICATE LOCATION(S) ON THE FACILITY SKETCH [LIC 999])

ELECTRICITY

WATER

GAS

VI. FIRST AID KIT (LOCATION)

VII. EQUIPMENT

SMOKE DETECTOR LOCATION (IF REQUIRED)

FIRE EXTINGUISHER LOCATION (IF REQUIRED)

TYPE OF FIRE ALARM SOUNDING DEVICE (IF REQUIRED)

LOCATION OF DEVICE

VIII. AFFIRMATION STATEMENT

AS ADMINISTRATOR OF THIS FACILITY, I ASSUME RESPONSIBILITY FOR THIS PLAN FOR PROVIDING EMERGENCY SERVICES AS INDICATED BELOW. I SHALL INSTRUCT ALL CLIENTS/RESIDENTS, AGE AND ABILITIES PERMITTING, ANY STAFF AND/OR HOUSEHOLD MEMBERS AS NEEDED IN THEIR DUTIES AND RESPONSIBILITIES UNDER THIS PLAN.

SIGNATURE

DATE

LIC 610 (10/03) (PUBLIC)

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