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gU,IN • • <br /> t' y <br /> N° 1584 $$ <br /> SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> � i OA <br /> HAZARDOUS MATERIAL DIVISION CiJoodbeiOfe L/2� <br /> INSPECTION FORM <br /> INSPECTION DATE_ �_r�� ARRIVAL TIME_%ee 3 __ DEPARTURE TIME <br /> BUSINESS NAMEPHONE__ <br /> BUSINESS ADDRESS�OCJx `_ w1 Q�r f/ f'/ _/ S✓�S _�J_y��d�y � �9/���__ <br /> FORM TYPE: _____SHORT _LONG _____FARM _____EXEMPT <br /> A. ADMINISTRATIVE INFORMATION <br /> Yes No/ Co s <br /> 1 . Business Plan available on-site <br /> _. Notification Information current _ <br /> 3. Staff Responsibilities current ___ - - ----- - <br /> 4. Plan signed/dated _ _ _ Ty�s til y _Ly�,<- <br /> 5. Evacuation Procedures posted _ _ �yIi.� <br /> b. 1/8 Mile Land Use noted ___ �S�_ '2L_� ✓1_✓_ <br /> 7. Safety/Spill/Monitoring Equipment <br /> 9. Clean-Up Company Phone # posted ___ __ ______ __ <br /> 4. Spill Containment Procedures <br /> 10. Nature of Business ___ <br /> 11 . Facility Diagram w/ Chemicals noted <br /> 12. Topographical Diagram ___ _ SE/6� d��lf �1l�lc✓ __ <br /> 13. Employee Training Records ___ _ _ 1C�•iE! �'({ C�c'f✓_�Z�A!e31a��cS <br /> 14. Waste Generator ___ 1!/_✓�le'� t'_'�Q.l .:'k'C,uLarw� <br /> 15. EPA Number for waste generators --______ <br /> ib. Chemical Inventory complete _-_ ___ - �_IF�PE_ �'P_�'/��-'_` • � <br /> --- <br /> B. HAZARDOUS_MATERIAL_SAFE_STORAGE_AND HANDLING_INFORMATION <br /> Yes No Comments <br /> 1. Material Safety Data Sheets on file -__ -__ . - 1--- - -------- <br /> Chemicals <br /> __-----_ <br /> Chemicals properly labelled <br /> 3. Chemicals properly stored _-- _-- /5 _ F <br /> ---- ------ <br /> 4. Safety Hazards ___ --- <br /> S. Housekeeping in order _____ ----------------___ <br /> b. Secondary Containment --- --- ------------------------ <br /> C. COMPLIANCE-VERIFICATION <br /> Inspector ----------------- --_ Date 96� <br /> Approved _____yes __L__no Follow-up Inspection Date <br /> Business Representative -AU _V //!0n2_5------------------- Title <br /> (print) <br /> �------------ <br /> (signature) <br /> white - oes <br /> canary - applicant <br /> pink - file <br />