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COUNTY OF SAN JOAQUIN <br /> ...cr OFFICE OF EMERGENCY SERVICES <br /> O <br /> " - ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> '•.:;�;rlr'" HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> — FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAMPPM 5 TELEPHONE <br /> fef <br /> BUSINESS AD RESS(Facilit ein Inspect _ 7& <br /> Jr <br /> O ` �t� ar[< <br /> FIRE DISTRICT INSPEC ION DATE JARRIVAYTIMEEPARTURETIMED1INSPECTIONTYPE <br /> rti»da 6 - -GS .2 LO n1 <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NjD FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site 17.Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees 18.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/HMMP Complete and Accurate . Employees Familiar with HMMP <br /> 4.If Business is a Hazardous Waste Generator, 0.Plant Operations Appear Safe - <br /> are Hazardous Waste Manifests On Site? 1.Hazardous Materials Being Properly Handled by Employee <br /> 5. Material Safety Data Sheets(MSDS)On SiteAll <br /> 2.Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 3.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) <br /> r� a <br /> L, <br /> D C` <br /> I 16T3�VaAt OLt <br /> A �. <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 INSPECTIONAZESULTS <br /> Business Rep seuln a(Print <br /> Na d Title) s veignature)0,2too - - 'in <br /> / <br /> Name of Inspector Ageney Fire Co. (If Appropriate) WHITE COPY: OES <br /> /„ Pa✓- PINKCOPY: BUSINESS REV 9/02 <br />