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DpO.U!N 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 /> INSPECTION FORM <br /> BUSINESS NAME PHONE NUMBER <br /> BUSINESS S ITE ADDRESS ZIP CODE FIRE DISTRKT <br /> 2 French CetMO2 Rd gy33(0 f=resh 6af w <br /> INSPECTION DATE ARRIVAL TI E/ DEPARTURE TIME INSPEC ION TYPE <br /> h - 6 - Ib � L 3 t � �►lrn <br /> A. ADMINISTRATIVE INFORMATION YES NO COMMENTS AND RECOMMENDATIONS <br /> PLAN AVAILABLE ON SITE <br /> SECTION 1: NOTIFICATION <br /> SECTION 2: EMERGENCY PROCEDURES <br /> SECTION 3: EVACUATION PROCEDURES <br /> SECTION 4: LEAK& SPILL CONTROL <br /> SECTION 5: TRAINING <br /> SECTION 6: FACILITY MAP 2 LA JPIAjf <br /> r� <br /> SECTION 7: INVENTORY <br /> B. STORAGE& HANDLING INFORMATION YES NO COMMENTS AND RECOMMENDATIONS <br /> WASTE GENERATOR <br /> M.S.D.S.AVAILABLE ON-SITE <br /> SECONDARY CONTAINMENT NOTED <br /> SAFETY HAZARDS <br /> CHEMICALS PROPERLY STORED K, <br /> CHEMICALS PROPERLY LABELED K <br /> CHEMICALS PROPERLY HANDLED <br /> C. COMMENTS AND RECOMMENDATIONS <br /> D. REFERRALS <br /> ❑ <br /> COMMISSIONER [:] HEA HEALTH ENVIRONMENTAL ❑ OSHA ❑ FICAL RE DEPT. ❑ POULUTIONC.D. ❑ OTHER <br /> E. COMPLIANCE VERIFICATION <br /> INSPECTION APPROVED: FOLLOW-UP INSPECTION DATE: MAIL IN REVISIONS DUE BY: <br /> [:] YES ❑ NO <br /> BUSINESS REPRESENTATIVE. (PRINTNAME) BUSINESS RE SENTATNE: 1SKf ) TITLJ:} <br /> DE4/✓ 4114 AIS5f1j X <br /> INSPECTOR: i SKINATURE: <br /> %1 WHITE COPY: O.ES. <br /> 1 t In L ICANARY COPY: FILE <br /> PINKCOPY: BUSINESS <br /> HM RaV:pEV.JUNE t992 <br />