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ARL <br /> i 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 /> BUSP,.WSS NAME TELEPHONE NUMBER <br /> �G''to -0/ S-7"5;� 1 11'77—z2,vt <br /> BUSINESS ADDRESS (Facility Being Inspected)2, <br /> 3 ��/oea / <br /> 77 v / <br /> /_� Y�e r e35? <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME I INSPECTION TYPE <br /> J am+ 11D -a8 -4n 09Sa Ac'v7 �P <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1.Business HMMP/Inventory On Site .Facility Map Complete and Accurate <br /> 2.HMMP/Map Easily Accessible to Employees .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 Employees <br /> 5. Material Safety Data Sheets (MSDS)On Site 72.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 � — �' /2420✓ 4R�41i J>�i�ON CLC. p'7 4..".-c, �O 'Q`'�' <br /> = 07Z kc-021- <br /> p,,e . ..p 4 °eaSb <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 /> ACKNOWLEDGE NT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> B ines Represe ive(Print Name and Title) Bus'ness epresentative ignature) <br /> ami of InspectOr � a /AgencyFire Co. (If Appropriate) WHITE COPY: OES REV 9/02 <br /> D� " PINK COPY: BUSINESS <br />