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pOU1N SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIALS DIVISION <br /> A 222 EAST WEBER AVENUE, ROOM 610A, STOCKTON, CA 95202 <br /> (209)468-3969 <br /> INSPECTION FORM <br /> BUSINESS NAME PHONE NUMBER <br /> G/8j--t-5 <br /> BUSINE ITE ADDRESS ZIP CODE FIRE DISTRICT <br /> �r_c <br /> INSPECTION DATE A IVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> A. ADMINISTRATIVE INFORMATION YES LNO COMMENTS AND RECOMMENDATIONS <br /> PLAN AVAILABLE ON SITE <br /> SECTION 1: NOTIFICATION <br /> SECTION 2: EMERGENCY PROCEDURES ng�e <br /> SECTION 3: EVACUATION PROCEDURES 1 <br /> SECTION 4: LEAK&SPILL CONTROL ` <br /> SECTION 5: TRAINING <br /> SECTION 6: FACILITY MAP f <br /> e <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 2 0 <br /> CHEMICALS PROPERLY HANDLED <br /> C. COMMENTS AND RECOMMENDATIONSI `` <br /> l , v,,, k ,, TO µt <br /> kc W o kY eL . <br /> e Se <br /> r_ < _/.I <br /> D. REFERRALS <br /> ❑ COMMISSK)AGRICUHTURE ❑ HEALTH NVIRONMENTAL ❑ OSHA ❑ FICAL <br /> RE DEPT.AL ❑ POLLUTION C.D. ❑ OTHER <br /> E. COMPLIANCE VERIFICATION <br /> INSPECTION APPROVE FOLLOW-UP INSPECTION DATE: MAIL IN REVISIONS DUE BY: <br /> [:] YES O v <br /> BUSINESS REPRESENTATIVE: RWTNAME) USINES>?REPRESENTATIVE ISO <br /> INSPECTOR: SKTNAjU <br /> WHITE COPY: a .S. <br /> CANARY COPY: FILE <br /> PINK COPY: BUSINESS <br /> HM <br /> m;REV.IUNE IM <br />