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r <br />0 <br />7Plr;G 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 <br />7oWe✓ PACArd <br />TELEPHONE NUMBER <br />BUSINESS ADDRESS (Facility Bein Inspeeccted) <br />�1 d <br />FIRE DISTRICT <br />Lot r►�d <br />INSPECTION DAYE <br />-c �-C-6- <br />ARRIVAL TIME <br />1 C,,� L <br />DEPARTURE IME <br />INSPECTION TYPE <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br />1. Business HMMP/Inventory On Site <br />17. Facility Map Complete and Accurate <br />2. HMMP/Map Easily Accessible to Employees <br />18. Chemical Inventory Complete and Accurate <br />3. Bus ID Page/HMMP Complete and Accurate <br />9. Employees Familiar with HMMP <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site? <br />10. Plant Operations Appear Safe <br />I 11. Hazardous Materials Being Properly Handled by Employee. <br />5. Material Safety Data Sheets (MSDS) On Site <br />1 <br />112. Hazardous Materials Properly Stored and Labeled <br />6. Current Training Records On Hand <br />1 <br />113. 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 <br />Follow Up Ins fiction Date <br />OES Inspector Name Performing Follow Up <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Bu ss Representative (Print Name and Title) <br />�I tJ - A "—'rt a M4k S <br />Business Repre�tative (Signature) <br />f <br />Name of Inspector t Agenc Fire Co. (If Appropriate) <br />WHITE COPY: OES <br />PINKCOPY: BUSINESS <br />I REV 9/02 <br />