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SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> i <br /> a <br /> HAZARDOUS MATERIALS DIVISION <br /> a 222 EAST WEBER AVENUE, ROOM 610A, STOCKTON, CA 95202 <br /> (209)469-3969 <br /> Q`"�"`'� INSPECTION FORM <br /> BUSINESS NAME <br /> PHONE NUMBER <br /> BUSINESS SITE ADDRESS 13 1 I Z1Pcr <br /> q _ / FIR I DISTRICT <br /> \13 �ED LIjoc1 Q� z3('.o Ll L`�1 <br /> INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <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: FACILFFY MAP <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 �c �ct <br /> SECONDARY CONTAINMENT NOTED <br /> SAFETY HAZARDS <br /> CHEMICALS PROPERLY STORED <br /> CHEMICALS PROPERLY LABELED <br /> CHEMICALS PROPERLY HANDLED <br /> C. COMMENTS AND RECOMMENDATIONS <br /> r- ���i`� ti�L <br /> D. REFERRALS <br /> COMM"I SIONN.IE.IRLTURE � HEn TENVIRONMENTAL � OSHA � FIRE DEPT. ❑ POLLUTION C.D. OTHER <br /> E_ COMPLIANCE VERIFICATION <br /> INSPECTION APPROVED: FOLLOW UP INSPECTION DATE: MAIL IN REVISIONS DUE BY: <br /> YES [—] NO <br /> 8US3 S REPRESENTATIVE :{PRINT NAME) ia—usiNE35 REPRESENTATIVE:.jSISxN£D} TITLE: <br /> � C� r r � G <br /> INSPECTOR: S IONATU RE: <br /> WHITE COPY: Q.E.S. <br /> CANARY COPY: FILE <br /> PINK COPY: BUSINESS <br /> k� HM INV:RPV.fUNE 17 <br />