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t: <br /> )o�G CAL <br /> _. N° 1280 8$ <br /> SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL DIVISION <br /> INSPECTION FORM <br /> INSPECTION DATE /Z= 3 ARRIVAL TIME_/=� DEPARTURE TIME/.`f� <br /> -- --- - ----- ----- <br /> BUSINESS NAME .�Qj��. C'A! PHONE gL63nl .�/ <br /> BUSINESS ADDR_ S_/SORT - <br /> ---------- <br /> ------- --------- <br /> -------- --------------------------- <br /> FORM TYPE: SHORT ___LONG ___ _ ARM _____EXEMPT <br /> A. ADMINISTRATIVE INFORMATION <br /> Yes No Comments <br /> 1. Business Flan available on-site <br /> --- ------------------------ <br /> 2. Notification Information current <br /> 3. Staff Responsibilities current <br /> 4. Flan signed/dated y� <br /> -- --- ------------------------ <br /> 5. Evacuation Procedures posted may_ <br /> --- <br /> b. 1/8 Mile Land Use noted X <br /> --- --- ------------------------ <br /> 7. Safety/Spill /Monitoring Equipment _X . <br /> --- ------------------------ <br /> B. Clean-Up Company Phone # posted X <br /> - --- ------------------------ <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 /> --- ------------------------ <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 /> ----------------------------------------- <br /> Yes No Comments <br /> 1. Material Safety Data Sheets on file <br /> --- ---------- -------- <br /> 2. Chemicals properly labelled X_ -------------- <br /> 3. Chemicals properly stored <br /> --- ---------- <br /> --- ------------------------ <br /> 4. Safety Hazards __ �- ------------------------ <br /> 5. Housekeeping in order <br /> b. Secondary Containment <br /> - -�----rr-- ---/�---- <br /> -t- --- ��.�SLi,�� -e�-L.�L1L��.✓ <br /> C. COMPLIANCE VERIFICATION <br /> Inspector �L�---Ll ------------------- Date <br /> Approved _yes -----no / Follow-up Inspection Date _______________ <br /> Business kepresentative Title <br /> pri ©Q A7/1-v.L <br /> nt) -y------ n1 <br /> (signature) <br /> white - oes <br /> canary - applicant <br /> pink - file <br />