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Qpck N C <br />2.. <br />2 N_ 1652 88 <br />Cq. P SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br />CjF�pe <br />HAZARDOUS MATERIAL DIVISION <br />INSPECTION FORM <br />INSPECTION DATE _�__ i_`� ARRIVAL T I ME_ I _,_� _ DEPARTURE TIME <br />BUSINESS NAME �( A <br />__ _y (' PHONE- ------------------------------- <br />BUSINESS ADDRESS__ __ �_______ <br />--------------------------- <br />FORM TYPE: _____SHORT _�ONG _____FARM _____EXEMPT <br />tip <br />ADMINISTRATIVE INFORMATION <br />-------------------------- <br />13. Employee Training Records <br />14. Waste Generator <br />15. EPA Number for waste generators <br />16. Chemical Inventory complete <br />-------------------------------------------------------------------------- <br />-------------------------------------------------------------------------- <br />B. HAZARDOUS MATERIAL SAFE STORAGE AND HANDLING INFORMATION <br />-------------------------------------------------------- <br />Yes No <br />1. Material Safety Data Sheets on file <br />Chemicals properly labelled <br />Chemicals properly stored _ <br />4. Safety Hazards f <br />5. Housekeep i i ig in order <br />6. Secondary Containment <br />Comments <br />------------------------ <br />------------------------ <br />C. MMPLIANCE_VERIFICATION <br />_K /1--1Inspector _� �_ __ Date ' %.-� ! _- <br />-------- -------------------- <br />Approved _lyes no Follow-up Inspection Date <br />Business Representative <br />white - oes <br />canary - applicant <br />pink - file <br />�-re ±t, Ci rY <br />rT/ n---- Ti tl e lL1P_ -_/ <br />r n t ) ly`, cL n "s. , r- <br />(signature) <br />Yeses No- <br />t. <br />Business Flan available on-site <br />C. <br />Notification Information current <br />Staff Responsibilities current <br />4. <br />Plan signed/dated <br />5. <br />Evacuation Procedures <br />6. <br />1/9 Mile Land Use noted <br />?. <br />Safety/Spill/Monitoring Equipment <br />9. <br />Clean -Up Company Phone # posted <br />4. <br />Spill Containment Procedures <br />10. <br />Nature of Business <br />11. <br />Facility Diagram w/ Chemicals noted <br />12. <br />Topographical Diagram <br />13. Employee Training Records <br />14. Waste Generator <br />15. EPA Number for waste generators <br />16. Chemical Inventory complete <br />-------------------------------------------------------------------------- <br />-------------------------------------------------------------------------- <br />B. HAZARDOUS MATERIAL SAFE STORAGE AND HANDLING INFORMATION <br />-------------------------------------------------------- <br />Yes No <br />1. Material Safety Data Sheets on file <br />Chemicals properly labelled <br />Chemicals properly stored _ <br />4. Safety Hazards f <br />5. Housekeep i i ig in order <br />6. Secondary Containment <br />Comments <br />------------------------ <br />------------------------ <br />C. MMPLIANCE_VERIFICATION <br />_K /1--1Inspector _� �_ __ Date ' %.-� ! _- <br />-------- -------------------- <br />Approved _lyes no Follow-up Inspection Date <br />Business Representative <br />white - oes <br />canary - applicant <br />pink - file <br />�-re ±t, Ci rY <br />rT/ n---- Ti tl e lL1P_ -_/ <br />r n t ) ly`, cL n "s. , r- <br />(signature) <br />