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COUNTY OF SAN JOAQUIN ....e-% <br /> OF" <br /> FC <br /> OFFICE OF EMERGENCY SERVICES .�0��ROOM 610,COURTHOUSE DEC - 2 2003 <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 hANwAW1NtiUUNjy <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 ► Et1FEMERGENCYSER CE <br /> - FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TE^LrEIPHONE NUMBER <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> \4S \ o \J . %' \AGS �'�7fLP CPK <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME JINSPECTION TYPE <br /> �\ o \\\\5 %MP <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.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, 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 /> 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) Busm ss Representative ignature) <br /> F er►w � C . !�-f. Leyt� <br /> Name of Inspector jAgency Fire Co.(If Appropriate) COPY: <br /> COPY: BUSINESS REV 9/0 <br />