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z i <br /> N° 1137 $$ <br /> SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL DIVISION <br /> INSPECTION FORM <br /> INSPECTION DATE_ ARRIVAL�' TIME_Q _ DEPARTURE TIME <br /> _�Q��__ <br /> BUSINESS NAME u'-'-C�F���- _ PHONE1 _ A1________________ <br /> BUSINESS ADDRES <br /> FORM TYPE: ____ SHORT LONG FARM _____EXEMPT <br /> A. ADMINISTRATIVE INFORMATION <br /> Yes No Comments <br /> 1. Business Plan available on-site <br /> --- ------------------------ <br /> �. Notification Information current <br /> --- ------------------------ <br /> Staff Responsibilities current <br /> -- ------------------------ <br /> 4. Plan signed/dated _ <br /> -- -- ------------------------ <br /> 5. Evacuation Procedures posted <br /> ------- <br /> b. 1/8 Mile Land Use noted <br /> 7. Safety/Spill/Monitoring Equipment x . __ ________________ <br /> 8. Clean-Up Company Phone # posted --- ------------------------ <br /> 9. Spill Containment Procedures <br /> 10. Nature of Business <br /> il . Facility Diagram w/ Chemicals noted <br /> --- --- <br /> 12. Topographical Diagram <br /> --- ------------------------ <br /> --- ------------------------ <br /> 13. Employee Training Records <br /> 14. Waste Generator x <br /> 15. 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 <br /> 2. --- ------------------------ <br /> Chemicals properly labelled <br /> 3. Chemicals properly stored <br /> 4. Safety Hazards <br /> - - ------------------------ <br /> 5. Housekeeping in order <br /> b. Secondary Containment x --- ------------------------ <br /> C. COMPLIANCE VERIFICATION <br /> ----- - - - -- -- - <br /> Inspector Date C._ <br /> --- -- - ----------------------- <br /> Approved _ _yes no Follow-up Inspection Date �_��� _ <br /> Business Representative ___[AUR? _)4 r1- Title 2 �0_)P, <br /> - - --- -- - ----- - - <br /> Pei( int <br /> (signature) <br /> white - oes <br /> canary - applicant y� <br /> pink - file ` ) <br />