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01 $/ fe JT/NCe 2©0 � <br /> a©sM. COUNTY OF SAN JOAQUIN / <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> 4R i z r R,.i� HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> �. FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINES NA TELEPHONE NUMBER <br /> m _ tI L C • FS-;f—c77(0% <br /> BUSINESS ADDRESS(F cility t.Being Inspected) <br /> FIRE gqISTRICT � ' INSPE TI DATE ARRIVAL TIME EPARTURE TIME I PECTION TYPE <br /> 41,ro p'�a�t+e Q7� 0 /05 / ' /70 0 1444 C_ P— <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, 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site? 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 expl fined in this section) I tx <br /> ' pZ � � ✓`G _ P0. • .S' <br /> eq,r <br /> OJ' ✓LE*1 Q l/t / dI✓ l! C_ O l <br /> //p.n 04 .6 h4 lit 1 µ K ' o ✓ Cw <br /> ✓" wL 1/��p r 2 0 r <br /> aZx I 2S C— - C C e c 4t -Z- /ems / / �1, <br /> p , <br /> 7 7 c. ©n <br /> S'G rccC�v � .�t✓2 <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> SPECTION FOLLOW UP INFORMATION <br /> orrecove 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 Repre ntative(Signature) <br /> Nam f I pllec5/to ��genc © ire Co. (If propriate) WHITE COPY: OES REV 9/02 <br /> r PINK COPY: BUSINESS <br />