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Pquih <br /> a c <br /> N° 0869 $$ <br /> "+ljFbitaSAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL DIVISION <br /> INSPECTION FORM <br /> INSPECTION DATE -�� ARRIVAL T I ME���!/'i�� DEPARTURE TIME_ <br /> BUSINESS NAME 4,,T fii C /+ 67'/e7PHONE_ _------- �'`---- <br /> BUSINESS ADDRESS , 5�3 _ ,? -----------_ <br /> FORM TYPE: -----SHORT _ _--LONG -----FARN EXEMPT <br /> A( ------- <br /> ADMINISTRATIVE <br /> ADMINISTRATIVE INFORMATION <br /> Yes No Comments <br /> 1 . Business Flan available on-site <br /> Notification Information current <br /> Staff Responsibilities current <br /> 4. Plan signed/dated _ __ _ <br /> C. Evacuation Procedures posted �.T � Ls�_rr�'G�/v� <br /> 6. 1 /8 Mile Land Use noted <br /> 7. Safety/Spill /Monitoring Equipment IN/ <br /> 8_ Clean-Up Company Phone # posted <br /> 9. Spill Containment Procedures <br /> 10. Nature of Business <br /> 11 . Facility Diagram w/ Chemicals noted �\, <br /> 1-2_ Topographical Diagram _ _-- -----------------I--,. Employee Training Records L <br /> --- <br /> 14_ Waste Generator -- <br /> - ------------------------ <br /> 15_ EPA Number for waste generators -------------------_-_--- <br /> --z------------------ --- <br /> ; , . <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 'y�- ___ ________________________ <br /> Chemicals properly labelled , _ --- ------------------------ <br /> 3. Chemicals properly stored <br /> IV- _ --.... <br /> ---------------------- <br /> 4. Safety Hazards -_ <br /> 5. Housekeeping in order 'fir - --_ ----- ------------ <br /> 6. Secondary Containment ___ �.=_ ------------ <br /> C_ COMPLIANCE VERIFICATION <br /> Inspector �---- ---------------------- <br /> C 1 <br /> j � Date <br /> i ------------------ <br /> *Approved \� __yesno Follow-up Inspection Date �Y-ZL4� _ <br /> Business Representat i ve - _�7}�_ i L�C6,�"' Ti t e / / / <br /> (s i lat u r e) <br /> white oes <br /> canary - applicant <br /> pink - file <br />