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4uiN • ' <br /> r.' <br /> _< N° 1244 88 <br /> •�q(icU0.N`p. SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL DIVISION <br /> INSPECTION FORM J� <br /> INSPECTION DATE_�1/11�_ ARRIVAL TIME_l �4_0 DEPARTURE TIME1�`Y <br /> BUSINESS NAME_ -T' - l�c��_/_%L PHONE <br /> BUSINESS ADDRESS_Z/ _111s y_ _ ��'7z�___ __ ______ <br /> FORM TYPE: SHORT LONG FARM EXEMPT <br /> A. ADMINISTRATIVE INFORMATION <br /> Yez/ No Comments <br /> 1 . Business Plan available on-site _✓✓✓ <br /> 2. Notification Information current <br /> 3. Staff Responsibilities current � __ ________________________ <br /> 4. Plan signed/dated --- ------------------------ <br /> 5. Evacuation Procedures posted -------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 /> --- ------------------------ <br /> 10. Nature of Business _ _ ________________ <br /> 11. Facility Diagram w/ Chemicals noted <br /> 12. Topographical Diagram <br /> 13. Employee Training Records <br /> 14. Waste Generator V / _______ <br /> 15. EPA Number for waste generators VV <br /> --- ------------------------ <br /> 16. Chemical Inventory complete <br /> -- --- ------------------------ <br /> B. HAZARDOUS_MATERIAL_SAFE_STORAGE_AND HANDLING_INFORMATION <br /> Yes No ments <br /> 1 . Material Safety Data Sheets on file __ __ ________________ <br /> 2. Chemicals properly labelled _ ___ ---------- <br /> 3. Chemicals properly stored _ __ 9iti_ -� <br /> 4. Safety Hazards _ _ <br /> in order <br /> v. Housekeeping <br /> -- - ---- <br /> 6. Secondary Containment _J �(_/���P G,' _____________ <br /> ------------------------ <br /> C. _M _IANCE_VERIFICATION <br /> Z�L - Date - <br /> Inspector �� <br /> Approvedyes _____no Follow-up Inspection Date / <br /> Business Representative _ Titley_ I��CcL¢ PecIce� , <br /> ---in <br /> --- -- - ----------- <br /> signature) <br /> white - oes <br /> canary - applicant <br /> pink - file <br />