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. •s•.:. z+arc utxa PAGE 02 <br /> Y COUNTY OF SAN JOAQUIN RECEIVE <br /> OFFICE OF EMERGENCY SERVICES t�` t <br /> ROOM 310,COURTHOUSE ! AR 1 <br /> .y Sj <br /> 222 EAST WEBER AVENUE SAN JOAQUIN COON <br /> � f STOCKTON. CALIFORNIA 95202 OFFICE OF EMERGENCY S CEE <br /> HAZARDOUS MATERIALS DIVISION(209)468-3939 <br /> -lel FAX(M9)941-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM ONE NUMBER <br /> BUS SS NAME ',1 __� .Z� —r� G�2 <br /> US SS ADI) ( acili dBein lnspect�Cl / I <br /> FIRE ISTRICT I IN t ION DATE ARRIVAL TUviF DEPARTURE TIME INSPECTIOrytiTYPE <br /> l A yl ), 0 <br /> INSPECTION RESULTS YES NO <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION <br /> I.Busimss IiMMP/invmtory On Site <br /> 7.Facility Map Complete and Accurate <br /> 2. miAW(Map Easity Accessible to Employees K 8.Chstnf;,al In�mrta.Y Complete and Accurm <br /> 3.Bus ID Page,'HMMP Ctmoplete and Aceturate 9.Employees Familiar with IIMMP <br /> I <br /> '4.If Business is a Hazardous W ante Getteratol. (�� ' <br /> 10.Plant Operations Appear Safc <br /> are Hazardous Waste Manifests On Site? I I.Ila�ardous Materials Beira Praperly Handled b Em l ec <br /> 'S.Materia)Safety Data Sheets(MSDS)On Site I2.Hazardous Materials PFOPCrIX SY"attdLabeted <br /> 6 Current Training Records On Hand i3.Soil a:.a sa i iy Appear Hoo Caaaminated <br /> COMMENTS(Ikms marked"N19'above mtut be explained in this section) <br /> 5 <br /> IF <br /> L.. i <br /> r <br /> v- <br /> a <br /> REFERRALS ❑SJ Ag G S3 Env$111h 0 OSHA 0 Fire ❑DA 0 <br /> MISPECTION FOLLOW OF INf01?MATION <br /> ^o- ' " 'p inspection Date OES Inspector Name Perfm nun Follow U <br /> 1;„ffrrea;a�e A=acn5 P-`.est Lk Tle'vetzd ec.C7EJ Hy �rvn4A' u B- � F <br /> 1 1 <br /> r CKNO�EDGEMENT OF REVIEW AND RECEIPT OF INSPECPION RESULTS <br /> �mec F sentatryP rPtint Name and Titte) Business Representative(Signauue) <br /> Nam f 95 . •:. Agency r, ,,.-c�-' Pireo.(If A.ppropr:ate) WHTIE . . , QES REV 4102 <br />