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COUNTY OF SAN JOAQUINIVF® <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE DEC -2 2003 <br /> �w. <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 bMuveMUUINuUUN1Y <br /> 4 r " i`✓' HAZARDOUS MATERIALS DIVISION(209)468-3969 FfICE.OFERAERGENC'/SERVICE <br /> r 6 e FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> \CW\9�0 a- %C6 ra <br /> FIRE DISTRICT INS ECTION DATE ARRIVAL TIME DEPARTURE TIME 1INSPECTIONTYPE <br /> %qQA 03 \3`kO fo \\N\0 E4%kw <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 Employee 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/FIMMP 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? JI.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 A13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explained in this section) <br /> 4t,6 !� <br /> "CCS. QjecaqjCs %XSC <br /> q. %>m *�Oq— c oJw <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Acti ns ust be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTIONRESULTS <br /> Business Representative(Print Name and Title) Business Re ative( ' nature) <br /> A A <br /> Name of Ins or Agency Fir (If A ropriate) COPY: OES REV 9/0 <br /> PINK COPY: BUSINESS <br />