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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ti <br /> ,A �4 ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)W-3969 <br /> FAX(209)9449015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NA I / TELEPHONE NUMBER <br /> Him )' <br /> I1 <br /> BUSINESS ADDRE S •acil' Being Inspected) <br /> FIREISTRI4 IN PECTION DATE ARRI fVfA11 L TIME DEPARTURE TIME INSPECTION TYPE <br /> ` S <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 OR ix <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, X 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 /> L. <br /> REFERRALS ❑SJ Ag ❑SJ Env HIth ❑OSHA ❑Fire ❑DA ❑_ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Co ective 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 Repr int ame and T e Business Representative(Signature) <br /> Na a of Ins t Agency Fire Co. (If Appropriate) WHITE COPY: OES <br /> nosPINK COPY: BUSINESS I REV 9/02 <br />