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COUNTY OF SAN JOAQUIN REOEIVE <br />OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE JAN 22 W <br />r 222 EAST WEBER AVENUE <br />STOCKTON, CALIFORNIA 95202 8AnJuAuutmu0UNIY <br />e ' <br />y?}' HAZARDOUS MATERIALS DIVISION (209Q69 �BOFEMEAGEEVCY SER <br />FAX (209) 944-9015 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME TELEPHONE NUMBER <br />De,l nod S l v, c_ 1241.308.15bK <br />2 3 YV1 Q ' o l i�d� 9 5 240 <br />FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME I INSP CCT`T II,ON TYPE <br />UL t I �-Dy[ 4 <br />L Business HMMP/Inventory On Site <br />2. HMMP/Map Easily Accessible to Employee <br />3. Bus ID Page/HMMP Complete and Accurate <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site? N <br />5. Material Safety Data Sheets (MSDS) On Site ✓ <br />6. Current Training Records On Hand <br />COMMENTS (Items marked "NO" above must be e <br />*,I . I -k -Q- +tMKP cu\&,L& Y1p-�- <br />6t—A- y <br />Facility Map Complete and Accurate <br />. Chemical Inventory Complete and Accurate <br />Employees Familiar with HMMP <br />D. Plant Operations Appear Safe <br />1. Hazardous Materials Being Properly Handled by 1 <br />2. Hazardous Materials Properly Stored and Labeled <br />3. Soil and Facility Appear Non -Contaminated <br />in this section) <br />Cil <br />r— <br />M <br />ITAW <br />REFERRALS ❑ SJ Ag ❑ SJ Env Mth ❑ OSHA ❑ Fire ❑ DA ❑ <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions Must be Delivered to DES By I Follow UD Insnection Date I OES Inspector Name Performing Follow Up <br />I- 2-0—D <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative (Print Name and Title) dgce Bus' s Representative (Siig ) W <br />A054IZ.ro .17L (6 A5 % J L60 A4"_ 1L �/ 'A nit. <br />COPY: BUSINESS I REV <br />