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^' Op4UIN c SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> <� HAZARDOUS MATERIALS DIVISION <br /> 222 EAST WEBER AVENUE, ROOM 610A, STOCKTON, CA 95202 <br /> (209)468-3969 <br /> 9CIFpPN <br /> INSPECTION FORM <br /> BUSINESS NAME PHONE NUMBER <br /> („ F. a IC71-4022 <br /> BUSINESS ADDRESSZIP CODE FIRE DISTRICT <br /> W CCA) <br /> ��eeF 7hp �T�crt <br /> INSPECTION DATE ARRIVALTIME DEPARTURE TIME INSPEC ONTYPE <br /> A.INFORMATION CURRENT YES NO B. STORAGEIHANDLING INFORMATION YES NO <br /> ✓ PLAN AVAILABLE ON SITE X WASTE GENERATOR J <br /> SECTION 1: NOTIFICATION ?( M.S.D.S.AVAILABLE ON-SITE x <br /> SECTION 2: EMERGENCY PROCEDURES X SECONDARY CONTAINMENT NOTED <br /> SECTION 3: EVACUATION PROCEDURES X SAFETY HAZARDS <br /> SECTION 4: LEAK&SPILL CONTROL x CHEMICALS PROPERLY STORED <br /> / SECTION 5: FACILITY MAP )C CHEMICALS PROPERLY LABELED <br /> SECTION 6: TRAINING PROGRAM& RECORDS )C CHEMICALS PROPERLY HANDLED <br /> SECTION 7: INVENTORY <br /> C. COMMENTS AND RECOMMENDATIONS: <br /> ST a�cd P us <br /> D. REFERRALS <br /> ❑ S.J.C.AGRICULTURE S.J.C.ENVIRONMENTAL CAL OSHA LOCAL S.J.C.AIR OTHER <br /> COMMISSIONER HEALTH FIRE DEPT. POLLUTION C.D. <br /> E. COMPLIANCE VERIFICATION <br /> FOLLOW-UP INSPECTION DATE'. MAIL IN REVISIONS DUE BY: <br /> USINESS REPRESENTATIVE: (PRINT NAME) BUSINESS REPRESENTATIVE: (SIG�jDL TITLE: <br /> L A4 2 2y Gv6 E ti/ X /'C/`- f3d.Ys'. Szsr, ccs <br /> INSPECTOR: O.E.S. <br /> OP <br /> CANARYCMUBV FILE <br /> PINK COPY <br /> : BUSINESS <br /> O.E.S H=.Mat 10(11/95) Hill INV:REV.NOV 1995 <br />