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N° 1719 88 <br /> C9l�FOA�\P SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL DIVISION <br /> INSPECTION FORM <br /> INSPECTION DATE_11��0 ___- ARRIVAL TIME_ DEPARTURE TIME___ <br /> BUSINESS NAME U-Haul 709-23 PHONE 473-0909 <br /> ----------------------- ------------------------------- <br /> BUSINESS ADDRESS7_701 T_amoshanter, Stock_t_on CA 95210 <br /> FORM TYPE: SHORT XXX LONG FARM EXEMPT <br /> ----- XXXLONG ----- <br /> -------------------------------------------------------------------------- <br /> A. ADMINISTRATIVE INFORMATION <br /> -------------------------- <br /> Yes/ No Comments <br /> 1 . Business Plan available on-site ✓ _ ________________________ <br /> _. Notification Information current = <br /> Staff Responsibilities current --- ------------------------ <br /> 4. Plan signed/dated XXX <br /> 5. Evacuation Procedures posted ___ _✓ ________________________ <br /> 6. 1/8 Mile Land Use noted XXX <br /> --- -=- ------------------------ <br /> 7. Safety/Spill/Monitoring Equipment . _XXX <br /> ------------------------ <br /> 8. Clean-Up Company Phone # posted ______________________ <br /> 9. Spill Containment Procedures _ -_- ------------------------ <br /> 10. <br /> __ __ _____________10. Nature of Business __� 7 Truck_& Trailer re_n_t_a_ls____ <br /> 11. Facility Diagram w/ Chemicals noted -Y- --- ------------------------ <br /> 12. Topographical Diagram $X --- ------------------------ <br /> 13. Employee Training Records <br /> 14. Waste Generator <br /> -- --- -------- <br /> 15. EPA Number for waste generators ✓ _cam f� / � <br /> 16. Chemical Inventory complete <br /> __z --- ------------------------ <br /> -------------------------------------------------------------------------- <br /> E. HAZARDOUS MATERIAL SAFE STORAGE AND HANDLING INFORMATION <br /> -------------------------------------------------------- <br /> Yes No Comments <br /> 1. Material Safety Data Sheets on file _✓ ____________ _ <br /> 2. Chemicals properly labelled / --- ------------------------ <br /> 3. Chemicals properly stored — _ ------------------------ <br /> 4. Safety Hazards __ - - ------------------------ <br /> 5. Housekeeping in order <br /> -- -- ------------------------ <br /> 6. Secondary Containment <br /> C. COMPLIANCE_VERIFICATION J <br /> Inspector _11tL2L Date �!1 <br /> Approved __✓yes -----no Follow-up Inspection Date <br /> Business Representative f �'_ � ------ Title6*4efL �W__ <br /> ----- - ----------- <br /> (signature) <br /> white - oes <br /> canary - applicant <br /> pink - file <br />