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Aft IL <br /> COUNTY OF SAN JOAQUI <br /> ow;l 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 /> 3CL,1Z 0 /1 S c, �'��'—4 210 <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> .Savo I"', , ✓e . . S 95'ZO <br /> FIRE DISTRICT INSPECTIONW <br /> 9ATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> ezu�• 2�a09d0 09,7o �lell ,10 <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site V1 7.Facility Map Complete and Accurate <br /> 2.HMMP/Map Easily Accessible to Employee 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page1HMMP Complete and Accurate 9. Employees Familiar with HMMP L <br /> 4. If Business is a Hazardous Waste Generator, , A n 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site? �! /T 11.Hazardous Materials Being Properly Handled by Employees <br /> 5. Material Safety Data Sheets (MSDS)On Site V 12.Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 13. Soil and Facility Appear Non-Contaminated C <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 RESMTS <br /> Bs Representative(Print Name and Title) <br /> Busin s epresentative(Si atu <br /> XL VP <br /> Name o for Ag r Fire Co. (If Appropriate) WHITE COPY: OES <br /> �- �J PINKCOPY: BUSINESS REV 9/02 <br />