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Z' 2 <br /> c' <br /> Y ` <br /> No 1463 <br /> �� <br /> •°+<�Fop.�`�• SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL DIVISION <br /> INSPECTION FORM <br /> INSPECTION DATE Z 91 ARRIVAL TIME { IO_ SI DEPARTURE TIME C/O <br /> BUSINESSNAMES ate_ �_---- PHONE2�g_ �c��_p7�2- _ - <br /> bUSINESS ADDFtE55 2 51_ yr�c1_ _Lan -------- <br /> FORM TYPE: -----SHORT -----LONG -----FARM <br /> _____EXEMPT <br /> A- ADMINISTRATIVE_INFORMATION <br /> Yes No Comments <br /> 1. Business Plan available on-site ✓ <br /> 2. -- --- -------------- <br /> Notification Information current ---------- <br /> Staff Responsibilities current <br /> -- --- ------------------------ <br /> 4. Plan signed/dated - � , --- ------------------------ <br /> 5. Evacuation Procedures posted <br /> 6. 1/8 Mile Land Use noted i/ ----------------------- <br /> 7. Safety/Spill /Monitoring Equipment . <br /> S. 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 /> a. Employee Training Records ---------- <br /> 14. Waste Generator f -- ------------------------ <br /> 15. -- <br /> --- - ------ <br /> EPA Number for waste generators ----------'-- <br /> 16. Chemical Inventory complete � - -- <br /> --- --- ------------------------ <br /> B. HAZARDOUS_MATERIAL_SAFE_STORAGE-AND HANDLING INFORMATION <br /> --- ------------------------ <br /> Yes No Comments <br /> 1 . Material Safety Data Sheets on file _V_� <br /> 2. Chemicals properly labelled -1/ -__ -- `---- <br /> �a L__ <br /> 3. Chemicals properly stored �_ ---- <br /> 4. Safety Hazards ----------------------- <br /> 5. Housekeeping in order ✓ t, _-'-------'----------- <br /> --- - --- <br /> 6. Secondary Containment i/ -------�----- <br /> _�� _ `= VZ_ <br /> C. r COMPLIANCE_VERIFICATION / <br /> Inspector es-�_ c-'----------------------- Date .� � 9 _ <br /> Approved __Z yes -----no Follow-up Inspection Date JJ// <br /> Business Representative __/�-�_ {�" / -%'le Title jhyv �U/Ze0i1f?y <br /> -- - -_A int) -------- 7_ ----- i <br /> ---- <br /> (sig tura) ------ <br /> white - oes <br /> *.anary - applicant <br /> ink - file <br />