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- I ; COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> PL tY� N /L iJC, <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> Sy sus- e- mac,o.! 9s-zos <br /> FIRE DISTRICT INSPECTION DATE JARRIVALTIME DEPARTURE TIME I INSPECTION TYPE <br /> ZZ 07 /1i41i4JP <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site 17.Facility Map Complete and Accurate f <br /> 2. HMMP/Map Easily Accessible to Employees 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/HMMP Complete and Accurate 9. Employees Familiar with HMMP <br /> 4.If Business is a Hazardous Waste Generator, 10,Plant Operations Appear Safe f <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 /> I&140✓e L/Our'ts 49-6-0.1 <br /> A Ya oe.9 a rr i <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION WULTS <br /> B ness Re�sentative(Priv Name and Title) Busin s epresenta v ignat e) <br /> u\ Lu,, � Mumu e � <br /> Name of Inspector Agency Fire Co.(If Appropriate ITE COPY: OES <br /> LOc✓EGL �e- ets PINK COPY: BUSINESS REV 9/02 <br />