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pOUIN SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> 10"..COG <br /> Z, HAZARDOUS MATERIALS DIVISION <br /> 222 EAST WEBER AVENUE, ROOM 610A, STOCKTON, CA 95202 <br /> p (209)468-3969 <br /> 91i0A�\ INSPECTION FORM <br /> BUSINESS NAME PHONE NUMBER <br /> q 7&- 5�) <br /> BUSINESS SITE ADDRESS ZIP CODE FIRE DISTRICT <br /> auawte�- �. 95,2/ Skllci vL <br /> INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> s -7 <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 V <br /> SECTION 4: LEAK& SPILL CONTROL <br /> SECTION 5: TRAINING <br /> SECTION 6: FACILITY MAP <br /> SECTION 7: INVENTORY L,-- <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 C <br /> CHEMICALS PROPERLY STORED <br /> CHEMICALS PROPERLY LABELED <br /> CHEMICALS PROPERLY HANDLED <br /> C. COMMENTS AND RECOMMENDATIONS <br /> D. REFERRALS <br /> CAL LOCAL S.J.C.AIR <br /> COMMISSIONERHEALTH <br /> [:] HEALTH ENVIRONMENTAL ❑ OSHA ❑ FIRE DEPT. ❑ POLLUTION C.D. ❑ OTHER <br /> E. COMPLIANCE VERIFICATION <br /> INSPECT PROVED: FOLLOWIIP INSPECTION DA LIN REVISIONS <br /> S [:] NO <br /> BUSINESS REPRESENTATIVE: PRINTNAME) BUSINESSIiEPRESENTATNE: 1SIGNEDJ TITLE: <br /> INSPECTOR: SK3NATUR WHITE C O.E.S. <br /> CANARY COPY: FILE <br /> EL vy,(; I PINK COPY: BUSINESS <br /> HMI W V:REV.JUNE 1991 <br />