Laserfiche WebLink
HAZARDOUS MATERIALS DISCLOSURE PROGRAM <br /> Stan DEPARTMENT OF <br /> ENVIRONMENTAL RESOURCES INSPECTION REPORT <br /> 3800 CORNUCOPIA WAY,SUITE C CALIFORNIA HEALTH & SAFETY CODE <br /> MODESTO,CA.95358 DIVISION, 20, CHAPTER 6.95 <br /> ly (209)525-5700 <br /> CALIFORNIA CODE OF REGULATIONS <br /> FAX#(209)525-6774 TITLE 19 <br /> BUSINESS NAME: <br /> f - DAtE: C.7 ? <br /> � � . <br /> BUSINESS ADDRESS: �i � �-•��-- rj <br /> If ) Initial ( ) Annual ( Reinspection/Notice follow-up { y Complaint/Request <br /> Yes No BUSINESS INFORMATION (Sections 25504 CCR 2729 2731 <br /> 1. Business identification information complete in business plan. <br /> RESPONSE PLAN INFORMATION (Sections 25504, 25505, CCR 2731, 2732) <br /> 2. Emergency response plaits and procedures complete. <br /> A) Emergency notifica"i^ne. P) Local emergency medical assistance. <br /> 3. Mitigation, prevention, and abatement of hazards -'written procedures. <br /> 4. Employee training program documented: annual and refresher courses established. <br /> 5. Business plan certified by appropriate person. <br /> INVENTORY INFORMATION (Sections 25505, 25509, 25509.3, CCR 2729) <br /> 5. Chemical inventory is complete, accurate and certified annually. <br /> 7. Treatment, disposal, and wast_ codec: reported. <br /> ' SITE/BUILDING MAP (Sections 25504, CCR 2729, 2730, 2731) <br /> 3. Site/Building r,:aF, is complc•t>� a.-Id idc.,tifies• <br /> Yes No Yes No <br /> a. North designated f. DOT codes/UN #s <br /> b. Building, storage, rooms, and other 9. Utility shutoff devices <br /> areas are numbered or lctte ^d h.aDry wells, storm drains, and <br /> c. Adjacent streets and property culverts <br /> d. Details of each floor (access & egress) i. Fire hydrants and fire ext. <br /> e. Evacuation routes and re-assembly ureas J. Emergency equipment . <br /> ' OFFICIAL NOTICE <br /> i <br /> 1 / <br /> r r�� �-'• r1-5 i' �s G <br /> i <br /> a <br /> r n <br /> YOU ARE HEREBY DI ACTED TO CORK CT THE DEF CIENCIES LISTED ABOVE WITHIN DAYS <br /> ,SAFETY RECOMMENDATIONS: <br /> 'INSPECT , ACCEPTED BY: / eve l— <br /> (PRINT) (SIGNATURE) <br /> 4013-456 OFFICE USE ONLY: I.D. # CFIRS # <br />