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ip <br /> SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIALS DIVISION <br /> 222 EAST WEBER AVENUE, ROOM 610A, STOCKTON, CA 95202 <br /> (209)468-3969 <br /> INSPECTION FORM <br /> BUSIN 5 E <br /> ( C� PHONUMBER <br /> BUSINESS SITE ADDRESSS <br /> !i v l ✓ I ` )_� <br /> TIME J�}i IZIP GZCr' F E TRICT <br /> INSPECTION DATE ARRIVAL T �JQ�., <br /> I/7 q �}Q DEPARTURE TIME INS gNVTY�PE <br /> / j 4V <br /> A. ADMINISTRATIVE INFORMATION YES NO COMMENTS AND <br /> PLAN AVAILABLE ON SITE RECOMMEmmmmm�NDATIONS <br /> SECTION 1: NOTIFICATION <br /> SECTION 2: EMERGENCY PROCEDURES <br /> SECTION 3: EVACUATION PROCEDURES <br /> SECTION 4: LEAK& SPILL CONTROL <br /> SECTION 5: TRAINING <br /> SECTION 6: FACILITY MAP <br /> SECTION 7: INVENTORY <br /> B. STORAGE& HANDLING INFORMATION YES NO COMMENTS AND RECOMMENDATIONS <br /> WASTE GENERATOR <br /> M.S.D.S.AVAILABLE ON-SITE <br /> SECONDARY CONTAINMENT NOTED <br /> SAFETY HAZARDS <br /> CHEMICALS PROPERLY STORED <br /> CHEMICALS PROPERLY LABELED <br /> CHEMICALS PROPERLY HANDLED <br /> C. COMMENTS AND RECOMMENDATIONS <br /> D. REFERRALS <br /> COMMISSIONER HEALTH <br /> HEALTH NVIROHMENTAL CAL <br /> LOCAL S.J.C.AIR <br /> OSHA O FIRE DEPT. POLLUTIONC.D. O OTHER <br /> E. COMPLIANCE VERIFICATION <br /> J ECTIONAPPROVED: FOLLOW-UP INSPFrCTION PANE: r MAIL IN REVLSONS DUE <br /> ES I] NO !. / J kj <br /> SUSWSSREPRESENTATTVE: (PRINTNAME). 7NESSRE7A7E: :ISIONED) T)TLEh <br /> h <br /> INSPECTOar' 3gNATU '� v WHITE COPY: O.E.S. <br /> ✓/ (; CANARY COPY: FILE <br /> PINK COPY: BUSINESS <br /> HM INV:RBV.IUNE l9! <br />