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SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> z HAZARDOUS MATERIALS DIVISION <br /> ` 222 EAST WEBER AVENUE, ROOM 610A, STOCKTON,CA 95202 <br /> (209)468-3969 <br /> Cq</Bpd� P INSPECTION FORM <br /> BUSINESS NAME PHONENUMBER <br /> p FI� 'DItW ( <br /> BUSINESS Ess aooREss L1 l <br /> LA o0 EZZO C�CC1�( 1 <br /> \� 1 <br /> INSPECTION DATE ARRtVALTIME JDPPARTURF TIME INSPECTION TYPE <br /> ( ) 10/9 1 9 .3o aid ( 1 14 <br /> A. ADMINISTRATIVE INFORMATION ENOCOMMEN.,TS AND RECOMMENDATIONS <br /> PLAN AVAILABLE ON SITE SECTION 1: NOTIFICATIONSECTION 2: EMERGENCYPROCEDURES <br /> SECTION 3. EVACUATION PROCEDURES SECTION 4: LEAK 8 SPILL CONTROL <br /> SECTION 5: FACILITY MAP <br /> SECTION 6: TRAINING <br /> SECTION 7: INVENTORY <br /> B. STORAGE& HANDLING INFORMATION YES NO COMMENTS AND RECOMMENDATIONS <br /> WASTE GENERATOR x �J S. <br /> M.S.D.S.AVAILABLE ON-SITE xY2 t L� �_ a <br /> SECONDARY CONTAINMENT NOTED <br /> SAFETY HAZARDS a CU1c <br /> CHEMICALS PROPERLY STORED <br /> CHEMICALS PROPERLY LABELED <br /> CHEMICALS PROPERLY HANDLED <br /> C. COMMENTS AND RECOMMENDATIONS <br /> O( k) <br /> 4 � �D. REFERRALS <br /> COMMISSIONER AGRICUL�RE HEALTH ENVIRONMENTAL OSHA FIRE AL DEPT POLLUTAIR ION C.O. OTHER - <br /> E. COMPLIANCE VERIFICATION <br /> INSPECTION APPROVED: FOLLOW-UP INSPECTION DATE: MAIL IN REV IONS DU BY' <br /> YES NO �— '� <br /> BUSINESS REPRESENT a E: (PRINT NAME) RUSINE RESENTAT (SIGNED) TITLE: <br /> 2 (/�' l7 n p1✓h 'o x f <br /> INS ! WHITE COPY: O.E.S. <br /> CANARY COPY: FILE <br /> PINK COPY: BUSINESS <br />