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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Acp llmaqO 60 <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> 2 /ie ne/h r1a,Y4 0 k 4 <br /> FIRE DISTRICT INSPECTIONJDAATTE JXRRIVALTIME DEPARTURE TIME INSPECTION TYPE <br /> rr&4%G it CGi M 2�� �+ ► �J k � � <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 S <br /> 2.HMMP/Map Easily Accessible to Employees 8.Chemical Inventory Complete and Accurate 4r <br /> 3.Bus ID Page1ID4MP Complete and Accurate 9.Employees Familiar with HMMP <br /> 4.If Business is a Hazardous Waste Generator, n I 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) Busin ssesentabe(Si n <br /> &\(Af \ Ed A er- <br /> Name of Inspector ftency <br /> t- Fire Co. (If Appropriate) WHITE COPY: OES <br /> PINKCOPY: BUSINESS REV 9/0 <br />