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a COUNTY OF SAN JOAQUIN <br /> "°� OFFICE OF EMERGENCY SERVICES <br /> is < 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 /> BUSINESS ADDRESS(Facility Being Inspected) <br /> V vV 1ilct <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTrIME INSPECTION TYPE <br /> Yhu n l L 2U l� /-Eb PW mp <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NU FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site 7.Facility Map Complete and Accurate ZS <br /> 2. HMMP/Map Easily Accessible to Employees 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/IIMMP Complete and Accurate 9. Employees Familiar with HMMP <br /> 4. If Business is a Hazardous Waste Generator, 10. Plant Operations Appear Safe ZSl <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 /> KP 1K <br /> rrz��f rV1 till <br /> REFERRALS ❑SJ Ag ❑SJ Env 111th ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actio s Must be Delivered to OES By Fol w U Inspection Date OES Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> % <br /> Name o nspector Agency Fire Co.(IFAppropriate) WHITECOPY: OES <br /> PINK COPY: BUSINESS REV 9/02 <br />