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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> <� ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> 0,1�10_- <br /> STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> TELEPHONE NUMBER <br /> BUSINESS NAME t / <br /> nl ton dY\ d( 4 L & t <br /> BUSINESS ADDRESS (Facility 13" Inspected) <br /> __7 ICUe <br /> FIRE DISTRICT INSPECTION DA ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> - -a1 el � lig m <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NCO, <br /> 1. Business HMMP/Inventory On Site 19 T.Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employee V' 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/HMMP Complete and Accurate 9. Employees Familiar with HMMP ?f <br /> 4.If Business is a Hazardous Waste Generator, / 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site? !� 11.Hazardous Materials Being Properly Handled by Employee <br /> 5. Material Safety Data Sheets(MSDS) On Site 12.Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) <br /> REFERRALS ❑SJ Ag ❑SJ Env Mth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Delivered to IDES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> Name of�tor Agency Fire Co. (If Appropriate) WH PY: OES REV 9/0 <br /> R4 �14PKK COPY: BUSRVESS <br />