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AgUlM <br /> Q :1� <br /> N: :< N° 1244 88 <br /> cq<«oaH�P SAN JOAQUIN COUNTY OFFICE OF EMERGENCY SERVICES <br /> HAZARDOUS MATERIAL DIVISION <br /> INSPECTION FORM JJ <br /> INSPECTION DATE_��`1j ___ ARRIVAL TIME 1_3_4_0 _DEFRTi RE T I MEI/=r�__ <br /> BUSINESS NAME _/�_�����Iy _ __ PHONE �� - ------------- <br /> BUSINESS ADDRESS_7/_5 1 _ <br /> FORM TYPE: SHORT LONG FARM EXEMPT <br /> A. ADMINISTRATIVE INFORMATION <br /> Y�7z No Comments <br /> 1 . Business Flan available on-site - -_-_-_ ----------------------------------------------- <br /> - <br /> Notification Information current <br /> Staff Responsibilities current _� _-_ ------------------------ <br /> 4. Plan signed/dated �,"/ --- ----------------------w_ <br /> 5. Evacuation Procedures posted � --- ------------------------ <br /> -_-_-_-_-_-_�_--_-__--_-_-_--_-_-_-__-_-- <br /> 6. 1/8 Mile Land Use noted 1 <br /> 7. Safety/Spill /Monitoring Equipment .. --- ------------------------ <br /> 8. Clean-Up Company Phone # posted _V- ___ ________________________ <br /> 9. Spill Containment Procedures ___ ------------------------ <br /> 10. Nature of Business _-_ ------------------.------ <br /> 11. Facility Diagram w/ Chemicals noted _ d 1L__ _ _µ,____----- <br /> 1^. Topographical Diagram _-- _ G�:.. U_Z...... <br /> ia. Employee Training Records ✓ _-- _ 1JlIEC_�1c�rL��`_'1 - <br /> 14. Waste Generator _�!� _-- -__ - ------------ <br /> 15. EPA Number for waste generators ------------------------ <br /> 16. <br /> ________________________ <br /> 16. Chemical Inventory complete <br /> B. HAZARDOUS_MATERIAL_SAFE_STORAGE_AND_HANDLING- INFORMATION <br /> Yes 7NO Csments <br /> 1 . Material Safety Data Sheets on file -- -'C ---------------- <br /> Z.. Chemicals properly labelled _ _ _ __ __------- <br /> 3. Chemicals properly stored _ - �_TJ_f! �r' _------ <br /> 4. Safety Hazards - <br /> 5. Housekeepi.iig in order __ -__ --- � � ------- <br /> 6. Secondary Containment - ____-___-_ <br /> C. Cdhl�LIANCE_VER-I-FICATION <br /> Date / <br /> InspectorKve!td <br /> v/ ___-Approved ___ ----_no Follow-up Inspection Date, z%)ZI e- <br /> Business Representative _ -- -- ------------ Title /�� A y � <br /> Aiviii <br /> signature) <br /> white - oes <br /> canary - applicant <br /> pink - file <br />