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P,CWlN <br /> 2: Z <br /> ur N° 1348 8 <br /> • � " SAP.! JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> 4C�FOR� <br /> HAZARDOUS MATERIAL DIVISION <br /> INSPECTION FORM <br /> INSPECTION DATE � 'Z _ ARRIVAL TIME__ _ DEPARTURE TIME__ •_1 <br /> BUSINESS NAME <br /> _ j�, �1 f ........ <br /> PHONE-------- ----------- <br /> BUSINESS ADDRESS- ----_''��533_�---R-,-----�C01----------------------- <br /> --------- <br /> FORM TYPE: _____SHORT _____LONG _____FARM XEMPT tJ1[ /V\Mtp <br /> -------------------- <br /> A. ADMINISTRATIVE INFORMATION <br /> ---------- --- - -------- <br /> Yes No Cc ments <br /> 1. business Plan available on-site _ _ E c V�i l�F_�;)_______ <br /> --- <br /> Notification Information current --- ------------------------ <br /> Staff Responsibilities current ` <br /> --- ------------------------ <br /> 4. Plan signed/dated __ ------------------------ <br /> 5. Evacuation Procedures posted =__ - ________________________ <br /> b. 1/8 Mile Land Use noted _______________ <br /> 7. Safety/Spill/Monitoring Equipment .. ________________________ <br /> 8. Clean-Up Company Phone # posted Y ------------------------ <br /> 9. <br /> ____________________9. Spill Containment Procedures _ � -------- --------- <br /> 10. Nature of Business __ �L� a_ <br /> _ Cr�LSR�S� K_ <br /> 11. Facility Diagram w/ Chemicals noted <br /> -- <br /> --- ------------------------ <br /> 12. Topographical Diagram ___ Z <br /> 13. Employee Training Records ___ _-_ �_{ ____________________ <br /> 14. Waste Generator -_-_____-____ <br /> --- <br /> 15. EPA Number for waste generators ___ ___ ----------------- ------ <br /> Ib. Chemical Inventory complete __- b6S -_ ______ <br /> -------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------- <br /> B. HAZARDOUS MATERIAL SAFE STORAGE AND HANDLING INFORMATION <br /> -------------------------------------------------------- <br /> Yes No Comments <br /> 1 . Material Safety Data Sheets on file _ ___ - _ ______ <br /> Chemicals properly labelled <br /> 1 ��_ <br /> 3. Chemicals properly stored ___ _ ____________________ <br /> 4. Safety Hazards ___ ___ ------------------- <br /> 5. Housekeeping in order _ _ A�______________ _ - <br /> b. Secondary Containment <br /> -------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------- <br /> C. COMPLIANCE VERIFICATION <br /> ----------------------- <br /> Inspector _ ------------------------- Date �^_�� <br /> Approved .....yes K_ no Follow-up Inspection Date <br /> Business Representative 1�2 J1-'' Ti tl e <br /> -�-- - ----------------- ------------ <br /> (print) <br /> ------------------------------- <br /> (signature) <br /> white - oes <br /> canary - applicant <br /> pink - file — FNre- 1:1"•P4:- , <br />