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COUNTY OF SAN JOAQUI14 "a <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> 7 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 /> ✓ac,C ih f <br /> BUSINESS ADDRESS(Facility Being Inspected <br /> 4�:!ro.z /ze,42A 1 /n <br /> FIRE DISTRICT INSPECTION DATE �ARRIVALTIME DEPARTURE TIME INSPECTION TYPE <br /> Y- X-01y oq/y of Y/ 11eUia_d;00 <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 Employees 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, <br /> / 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site? N 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 /> 9- kce� adee,,A­oNa-e <br /> c. gU_e44�� <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 Representative(Signature) <br /> Name of Inspector �/ Agency Fire Co. ( f ppro ' te) WHITE COPY: OES <br /> aQT QZc.�.e- �-9�"- 146 PINK COPY: BUSINESS REV 9/02 <br />