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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> q ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> '<,L+F.O. , 41 HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME I TELEPHONE NUMBER <br /> 4e�� 7— T-0 <br /> -13 <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> /f'9v1 70--e- <br /> FIRE <br /> -u <br /> FIRyyEE��DISTRIICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> /�G 944e 4tu� 1 5-- 6 O /n : 0.0 1 <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site 7.Facility Map Complete and Accurate <br /> 2. HMME/Map Easily Accessible to Employees 8. Chemical Inventory Complete and Accurate <br /> 3. Bus ID Page/HNIMP Complete and Accurate 9. Employees Familiar with HMMP <br /> 4. If Business is a Hazardous Waste Generator, n 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site? TI 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 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 /> Business Representative(Print Name and Title),/ Business Represen e <br /> e( ) <br /> Name o Inspector //�� a.�ggency Fire Co. (If Appropriate) COPY: OBS <br /> 1Ve/ 4-r _Cz4v#V-> �rti,,�oye � � PI OPY: BUSINESS REV 9/0 <br />