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pgpip • • <br /> < N° 0390 88 <br /> b' < <br /> SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL DIVISION <br /> INSPECTION FORM <br /> INSPECTION DAT _� ARRIVAL TIMET yr DEPARTURE TIME <br /> BUSINESS NAMEIj DU _ 6 ___ PHONEn _ 7� t <br /> BUSINESS ADDF:ESS 1GLL��_ �`�Zts+--��LL/� -L!T------------------ <br /> FORM TYPE. _SHORT -----LONG _____FARM -----EXEMPT <br /> A. ADMINISTRATIVE INFORMATION <br /> YeS� /Na -----_Comments--------_- <br /> 1 . Business Flan available on-site VVV <br /> 2. Notification Information current <br /> --- --- <br /> ------------------------ <br /> Staff Responsibilities current ________________________ <br /> 4. Plan signed/dated ------------------------ <br /> 5. Evacuation Procedures posted ________________________ <br /> 6. 1/8 Mile Land Use noted ___ ------------------------ <br /> 7. Safety/Spill/Monitoring Equipment . __- --- ------------------------ <br /> 9. Clean-Up Company Phone # posted --- ------------------------ <br /> 9. Spill Containment Procedures --- --- ------------------------ <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 --- ------------------------ <br /> 15. EPA Number for waste generators -- --- ________________________ <br /> 16. Chemical Inventory complete ___ ---_____________________ <br /> B. HAZARDOUS_MATERIAL_SAFE_STORAGE_AND_HANDLING_INFORMATION <br /> Yes No Comments <br /> 1. Material Safety Data Sheets on file <br /> 2. Chemicals properly labelled _ ___ ________________________ <br /> 3. Chemicals properly stored ----- <br /> 4. Safety Hazards _ �1P��c1o_IIZ�i— (�uL 5 <br /> 5. Housekeeping in order - - --- ------------------------ <br /> 6. Secondary Containment --- --- ------------------------ <br /> C. C MPLIANCE_VE_R_IFICATION <br /> Inspector _ v -_- ------- <br /> Date <br /> - --- -------------- <br /> Approved __LZ/`yes -----no Follow-up Inspection Date <br /> Business Representative _- --------- '________________ <br /> Title c <br /> � ( int) <br /> ----------- <br /> nature) <br /> white - oes <br /> canary - applicant <br /> ,ink - file <br />