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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> t 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 /> Zoe CZ41 Awa'-,6�0.4 _.kte_ sg3 - Cosa <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> 6/ooS 1�,eOH S�O� <br /> FIRE DISTRICT IN PECTION DATE ARRIVAL TIME DEPARTURE TIME I INSPECTION TYPE <br /> �S ,roH <br /> 3-Y-03 u g o% <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/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 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 /> aac cz C� 3 -/e/-03. <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 /> 3— /y- 03 <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESUL <br /> Business Representative(Print Name nd Title) Business entative(Signat ) <br /> Nam of Inspector n a_-c�/_ Agency ire Co. (If Appropriate) rrE OPY: OFS REV 9/02 <br /> q J7-'Z- a ��� PINKCOPY: BUSINESS <br />