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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> 04�f : <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> L -e v rri Y1 It- 7 3 <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> FIRE DISTRICT INSPECTION DATE JARRIVALTIME DEPARTURE TIME INSPECTION TYPE <br /> 0a oto <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 d <br /> 2.HMW/Map Easily Accessible to Employees 18.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/IIMMP Complete and Accurate 9. Employees Familiar with HMMP <br /> 4.If Business is a Hazardous Waste Generator, Q 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 /> add <br /> Cv d �fiv 1h) <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 RESULTS <br /> Busines epresentativ (Print Nam a d Title) Miresent a(Signature) <br /> Name of Inspector gency opriate) =COPY <br /> OES <br /> PINKCOPY: BUSINESS I REV 9/0 <br />