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1W we <br /> r c <br /> N° 0566 88 <br /> " SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> ��FOP <br /> HAZARDOUS MATERIAL DIVISION <br /> INSPECTION FORM <br /> INSPECTION DATEZ,2ZZ12A2 __ ARRIVAL TIME_y.dQ _ DEPARTURE TIME) .-4ga_ <br /> BUSINESS NAMEQ��_1� Y�_ ��/ F'HONEpy66_�y�i .............. <br /> BUSINESS ADDRESSOZ3J��rf�_�JLO�i�c�6---- Jim---Gy--91�?QG------- <br /> FORM TYPE: SHORT _,�f,-_LONG FARM EXEMPT <br /> -------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------- <br /> A. ADMINISTRATIVE INFORMATION <br /> Yes No Comments <br /> 1. Business Flan available on-site <br /> Notification Information current <br /> Staff Responsibilities current V- --- ------------------------ <br /> 4. Plan signed/dated V. ___ ________________________ <br /> 5. Evacuation Procedures posted _7- <br /> 6. 1/8 Mile Land Use noted _� <br /> 7. Safety/Spill/Monitoring Equipment . <br /> 8. Clean-Up Company Phone # posted ______________________ <br /> 9. Spill Containment Procedures <br /> 10. Nature of Business 6! <br /> - - --- ------------------------ <br /> 11. Facility Diagram w/ Chemicals noted IO <br /> -- --- ------------------------ <br /> 12. Topographical Diagram _ ___ ________________________ <br /> 13. Employee Training Records _�/ ___ ________________________ <br /> 14. Waste Generator <br /> 15. EPA Number for waste generators y _ <br /> --- - ----- --- ---------- <br /> 16. Chemical Inventory complete _j�[___ <br /> B. HAZARDOUS MATERIAL SAFE STORAGE AND HANDLING INFORMATION <br /> Yes No Comments <br /> 1. Material Safety Data Sheets on file ✓ <br /> -7 ----------------------- <br /> 2. Chemicals properly labelled <br /> --- --- ------------------------ <br /> 3. Chemicals properly stored _L/_ ---------------_________ <br /> 4. Safety Hazards _ _ -Z ------------------------ <br /> 5. Housekeeping in order -Z <br /> 6. Secondary Containment <br /> --- ------------------------ <br /> C. COMPLIANCE VERIFICATION <br /> ----------------------- <br /> Inspector �e1111�.L__FG��iC --------------------- Date f�� �_--- <br /> Approved __1/ yes _____no Follow-up Inspection Date <br /> Q� / d <br /> 1fllL�i1 s_,i_-- <br /> Business Representative Title <br /> ���///��' T— - - --- <br /> (signature <br /> white - oes <br /> canary - applicant <br /> pink - file <br />