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/O:OU <br /> No 0956 88 <br /> •��G(k 6a+"• SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL DIVISION <br /> INSPECTION FORM <br /> INSPECTION DATE 3� s L4 ( _ ARRIVAL TIME_ DEPARTURE TIME_��'__ _ <br /> BUSINESS NAME PHONE_____ <br /> BUSINESS ADDRESS__ u <br /> FORM TYPE: SHORT _X_LONG FARM EXEMPT <br /> A. ADMINISTRATIVE INFORMATION <br /> -------------------------- <br /> Y,es No Comments <br /> 1 . Business Plan available on-site x <br /> --- --- --------------- <br /> 2. Notification Information current ------ <br /> 3. Staff Responsibilities current � --- ------------------------ <br /> 4. Plan signed/dated Y --- ------------------------ <br /> 5. Evacuation Procedures posted �� --- ------------------------ <br /> 6. 1/9 Mile Land Use noted <br /> 7. c4'fete S i Monitoring Equipment. X _ _______________ <br /> 9. Clean-Up Company Phone # posted x - ---------- <br /> 9. Spill Containment Procedures ,_ ___ <br /> ---------- ----- <br /> 10. Nature of Business ��r� y�jj_�____orS__ <br /> 11. Facility Diagram w/ Chemicals noted _ ___ ________________________ <br /> 12. Topographical Diagram X_ ___ ________________________ <br /> 13. Employee Training Records <br /> --- ------------------------ <br /> 14. Waste Generator <br /> 15. EPA Number for waste generators <br /> -- --- ------------------------ <br /> 16. Chemical Inventory complete ------------------------ <br /> B. HAZARDOUS_MATERIAL_SAFE_STORAGE_AND HANDLING_INFORMATION <br /> Yes No Comments <br /> 1 . Material Safety Data Sheets on file _ ------ l <br /> 2. Chemicals properly labelled _`�`a-� e] C i e LL��1 L3hA <br /> 3. Chemicals properly stored <br /> 4. Safety Hazards <br /> 5. Housekeeping in order <br /> 6. Secondary Containment ___ }� <br /> C. COMPLIA ___VER FICATI_ON_ <br /> Inspector ------ Date <br /> Approvedyes 6 <br /> Follow-up Inspection Date 111- <br /> Business Representative Title <br /> ( nt) <br /> Zsignature) <br /> white - oes <br /> canary - applicant <br /> pink - file <br />