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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 /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> BUSINESS NAME <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> OF /-06" TELEPHONE NUMBER <br /> BUSINESS ADDRESS (Facility Being Inspected) 333"6,7uro <br /> 2/o Gt/ <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> -0 3 <br /> DOCUMENT REVIEW INSPECTION RESULTS <br /> 1.Business HMMPQnventory On Site YES NO FACILITY INSPECTION YES NO <br /> 7.Facility Map Complete and Accurate <br /> 2.HMMP/Map Easily Accessible to Employee 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page1HMMP Complete and Accurate 9. Employees Familiar with HMMP <br /> 4.If Business is a Hazardous Waste Generator, 10. Plant Operations A <br /> are Hazardous Waste Manifests On Site? N Appear Safe <br /> 11.Hazardous Materials Being Properly Handled by Employees <br /> 5. Material Safety Data Sheets (MSDS) On Site 12.Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 611113.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) <br /> CA"UPT --MA4 P1 Ui G a,!l 4 <br /> dtZ S-/7-o <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 /> S-%q-v3 <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Busine s pres alive(Signature) <br /> bV-lq k <br /> Namc,of Inspector /J,,,,,� Ag ncy Fire Co. f Approp late) WHITE COPY: OES <br /> /LL/ CSC/(/ PINK COPY: BUSINESSV 9/02 <br />