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COUNTY OF SAN JOAQUIN RECEIVED <br /> OFFICE OF EMERGENCY SERVICES <br /> MAR - 4 20M <br /> �I ROOM 610,COURTHOUSE SAN JOAOUIN COUNTY <br /> 222 EAST WEBER AVENUE OFFICE OF EMERGENCY SEFMCM <br /> STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 AJC ,��5 �R`6S <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME r TELEPHONE NUMBER <br /> 0 U11\e. �eA g' r <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> I'752 ave sa %b CA 915-b15' <br /> FIRE DISTRIC �RkSPE TION DATE ARRIVALIM <br /> TE DEPARTURE TIME INSPECTION TYPE <br /> 5 2 : oo <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site 17.Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees V8. Chemical Inventory Complete and Accurate <br /> 3. Bus ID Page/IIMMP Complete and Accurate 9. Employees Familiar with HMMP <br /> 4. If Business is a Hazardous Waste Generator, N 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site? K 11.Hazardous Materials Being Properly Handled by Employee: <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 /> 'n KUi2 MS n QI. <br /> -z'I' to <br /> V1 cA r \I CtA,✓r Y rd.S- <br /> lt 'n I np rals . <br /> REFERRALS ❑SJ Ag ❑ SJ Env 111th ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Delivered to DES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Represen uve(Print Name and Title Business Re resentati (Signature) <br /> o M AV <br /> Nam Inspector Agency Fire Co.(If Apprdrriate) WHITE COPY: OI <br /> PINKCOPY: BUSINESS I REV 9/02 <br />