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HAZARDOUS MATERIAL$. DISCLOSURE PROGRAM <br /> SJO/I ' DEPARTMENT OF INSPECTION REPORT <br /> ENVIRONMENTAL RESOURCES <br /> 3800 CORNUCOPIA WAY,SUITE C CALIFORNIA HEALTH 6 SAFETY CODE <br /> M00EST0,CA.95358 DIVISION, 20, CHAPTER 6.95 <br /> ly (209)525-6700 CALIFORNIA CODE OF REGULATIONS <br /> FAX#(209)525-6774 j TITLE 19 <br /> x <br /> B <br /> USINESS NAME: <br /> ADDRESS: <br /> ( ) Initial ( ) Annual ( Reinspection/Notice follow-up ( ) Complaint/Request <br /> Yes No BUSINESS INFORMATION (Sections 25504, CCR 2729, 2731) <br /> 1. Business identification information complete in business plan. <br /> RESPONSE PLAN INFORMATION (Sections 25504, 25505, CCR 2731, 2732) <br /> 2. Emergency response plans and procedures complete. <br /> A) Emergency notifications. E) Local emergency medical assistance. <br /> 3. Mitigation, prevention, and abatement of hazards - written procedures. <br /> 4. Employee training program documented: annual and refresher courses established. <br /> 5. Business plan certified by appropriate person. <br /> INVENTORY INFORMATION (Sections 25505, 25509, 25509.3, CCR 2729) <br /> r_ 6. Chemica inventory is complete, accurate and certified annually. <br /> 7. Treatment, disposal, and waste codes reported. <br /> SITE/BUILDING MAP (Sections 25504, CCR 2729, 2730, 2731) <br /> S. Site/Building map is complete a::-'. :dcntifies: <br /> Yes No Yes No <br /> _ a. North designated f. DOT codes/UN #s <br /> _ b. Building, storage, rooms, and other g. Utility shutoff devices <br /> areas are numbered or lettered h.'Dry wells, storm drains, and <br /> c. Adjacent streets and property culverts <br /> _ d. Details of each floor (access & egress) 1. Fire hydrants and fire ext. <br /> e. Evacuation routes and re-as5ambly areas j. Emergency equipment <br /> ` OFFICIAL NOTICE <br /> -O e a` G r S li/o., , <br /> C <br /> r - /- <br /> / <br /> r <br /> A <br /> r ' <br /> ,2 to/ 2eF Z C yo e <br /> r YOU ARE HEREBY DIACTED TO CORK CT THE DEFICIENCIES LISTED ABOVE NITHIN DAYS <br /> SAFETY RECOMMENDATIONS: <br /> INSPECT DL R:_ ` ACCEPTED BY: > l ever <br /> (PRINT) (SIGNATURE) <br /> 4013-456 OFFICE USE ONLY: S.D. # CFIRS # <br />