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PQ U,INcl SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> to HAZARDOUS MATERIALS DIVISION <br /> 222 EAST WEBER AVENUE, ROOM 610A, STOCKTON, CA 95202 <br /> (209)468-3969 <br /> " INSPECTION FORM <br /> 4LIFOAN <br /> BUSINESS NAME PHONE NUMBER <br /> C a✓f4r1,c A+ L ,n S c.S v6 6 - �/3/ <br /> BUSINESS ADDRESS ZIP CODE FIRE DISTRICT <br /> 41Y8O S, lfw 91 / S�o n 9 S-Z/ 5- /e �a n n <br /> INSPECTION DATE ARRIVALTIME DEPARTURE TIME INSPECTION TYPE <br /> n <br /> 0,46, 9 /7 3c' �vI 'lfs_ /-S—" <br /> T c HIn NI" <br /> A.INFORMATION CURRENT YES NO B. STORAGE/HANDLING INFORMATION YES NO <br /> PLAN AVAILABLE ON SITE WASTE GENERATOR <br /> SECTION 1: NOTIFICATION M.S.D.S.AVAILABLE ON-SITE <br /> SECTION 2: EMERGENCY PROCEDURES SECONDARY CONTAINMENT NOTED <br /> SECTION 3: EVACUATION PROCEDURES SAFETY HAZARDS t <br /> SECTION 4: LEAK&SPILL CONTROL CHEMICALS PROPERLY STORED <br /> SECTION 5: FACILITY MAP CHEMICALS PROPERLY LABELED <br /> SECTION 6: TRAINING PROGRAM& RECORDS jZ CHEMICALS PROPERLY HANDLED <br /> SECTION 7: INVENTORY <br /> C. COMMENTS AND RECOMMENDATIONS: <br /> log K e kk <br /> 7 all -hm . <br /> II <br /> O. C C5,/.5 C e a O l4iid 4 EA! 9U.� <br /> C <br /> - .. <br /> l A rqJZ- G / S <br /> D. REFERRALS <br /> COMMISSIONER AGRICULTURE ❑ HEALTH ENVIRONMENTAL CAL OSHA ❑ F C OTHER <br /> DEPT. POLLUTION C.D. <br /> E. COMPLIANCE VERIFICATION <br /> FOLLOW-UP INSPECTION DATE: MAIL IN REVISIONS DUE BY O C / / l� <br /> BUSINESS REPRESENTATIVE: (PRINT NAME) BUSINESS REPRESENTATIVE: (SIGNED) rl� <br /> LE. <br /> e �/ X <br /> VMRE COPD. OE S <br /> INSPECTOR: CANARYCOPY: FILE <br /> L/ PIWCOPY BUSINESS <br /> nb e4 � V "e-Z `' <br /> HM INV:REV.NOV 1995 <br /> O.E.S-Hu.Mat 10(11/95) <br />