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COMPLIA E VERIFICATION <br />Date no Follow-up Inspection <br />C. <br />Inspector <br />Approved __yes <br />Date el 1 S(/ <br />NE' 0756 88 <br />SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br />HAZARDOUS MATERIAL DIVISION <br />INSPECTION FORM <br />INSPECTION DATEg"05icr( ARRIVAL TIME /;;/5 DEPARTURE TIME 0>t, 6 <br />BUSINESS NAME_ .51-11/41,eive-c/thivilr_ PHONE_93&752L <br />BUSINESS ADDRESS) &J_LAitisAac 9..:242 <br />FORM TYPE: SHORT LONG FARM EXEMPT <br />A. ADMINISTRATIVE INFORMATION <br />1. Business Plan available on-site <br />Notification Information current <br />Staff Responsibilities current <br />Plan signed/dated <br />Evacuation Procedures posted <br />1/8 Mile Land Use noted <br />Safety/Spill/Monitoring Equipment <br />Clean-Up Company Phone # posted <br />9- Spill Containment Procedures <br />Nature of Business <br />Facility Diagram w/ Chemicals noted <br />Topographical Diagram <br />Employee Training Records <br />Waste Generator <br />EPA Number for waste generators <br />Chemical Inventory complete <br />Yes No Comments <br />_t__1L4C_Set- -Caa-ri4e-F <br />---";-1/5it--4eo4 9 cr4— s--5 <br />_GA.44NzAr _thaf:fr. <br />7710(aaa <br />E vj2Qici Ii\-).( <br />B. HAZARDOUS MATERIAL SAFE <br />C441 q v e vse 1440\ <br />STORAGE AND HANDLING INFORMATION <br />Material Safety Data Sheets on file <br />Chemicals properly labelled <br />Chemicals properly stored <br />Safety Hazards <br />Housekeeping in order <br />Secondary Containment <br />Business Representative <br />white - oes <br />canary - applicant <br />pink - file <br />dL Title <br />( (print) <br /> I1 — ei„,4f,c_k e_411s ignature) <br />P/L4-'444-4P. <br />&)f-