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r 0 <br /> 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)9449015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS A TELEPHONE NUMBER <br /> I Lut, h � <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> FIRE DISTR CT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <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 2r <br /> 2. HMMP/Map Easily Accessible to Employees 8.Chemical Inventory Complete and Accurate zf <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 i{ <br /> are Hazardous Waste Manifests On Site? A 11.Hazardous Materials Being Properly Handled by Employee Y <br /> S. Material Safety Data Sheets(MSDS) On Site 12.Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand I y 113. Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explained in this section) l <br /> I LOIi ►'Ia� � �l -G c- L-' � t�GL M. C %/LC r� <br /> w �t 11a r <br /> 41" hl-e <br /> REFERRALS ❑SJ Ag ❑SJ Env HIth ❑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 RESULTS <br /> Business Representative(Print Name and Title) Business °nature) <br /> icGYt _ - <br /> Name of Inspector f y� Affncy Fire Co. OES <br /> ✓�.SIcq PINK COPY: BUSINESS I REV 9/0 <br />