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2' N° 0934 $$ <br /> °+�;Fo;,,:�°• SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL DIVISION <br /> INSPECTION FORM <br /> INSPECTION DATE __ ll�[1___ ARRIVAL TIME__�/1�U DEPARTURE TIME_________ <br /> BUSINESS NAME C_v_,j/__ + _hTATs_ r',7y PHONE____________ _----------------- <br /> - <br /> ____ __ _____ <br /> BUSINESS ADDRESS^-- -- --�'= -�� �'T- ----- _4SL �° ----------------- <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 /> 5. Evacuation Procedures posted <br /> 6. 1/8 Mile Land Use noted <br /> 7. Safety/Spill/Monitoring Equipment. <br /> --- --- ------------------------ <br /> 8. Clean-Up Company Phone # posted <br /> --- --- -------------- ---- <br /> 9. Spill Containment Procedures <br /> --- --- ------------------------ <br /> 1 . Nature of Business <br /> 111. Facility Diagram w/ Chemicals noted _ ------------------------ <br /> __________________-___- <br /> i?_ Topographical Diagram V <br /> -- ------------------------ <br /> 13. Employee Training Records <br /> --- --- ------------------------ <br /> 14. Waste Generator <br /> --- --- ------------------------ <br /> 15. EPA Number for waste generators _ ___ ________________________ <br /> 16. Chemical Inventory complete ________________________ <br /> -------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------- <br /> B_ HAZARDOUS MATERIAL SAFE STORAGE AND HANDLING INFORMATION <br /> Yes o Comments <br /> 1. Material Safety Data Sheets on file ___ ________________________ <br /> 2. Chemicals properly labelled __________________ <br /> 3. Chemicals properly stored <br /> 4. Safety Hazards <br /> 5. Houset:eeping in order ___ ________________________ <br /> b. c7amYn <br /> ______________________________________________ <br /> C. COMPLIANCE VERIFICATION <br /> --- ------------------ <br /> Inspector � Vi �f/��Date <br /> Approved - - -y, ---- <br /> es no Follow-up Inspection Date <br /> Business Representative <br /> c\ � a�,/_U��'/l ------ Title <br /> ( i ) <br /> ----------- - ----- -- <br /> (signature) <br /> white - oes <br /> canary - applicant <br /> pink - file <br />