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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)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> A-P <br /> BUSINESS ADD SS(Facility Being Inspected) <br /> 2 d- oc k <br /> FIRE DISTRICT INSPECTION DATE JARRIVAL TIME EPJRTURETWE INSPECTION TYPE <br /> r tfY l --6t 10 t-4,5- <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 18.Chemical Inventory Complete and Accurate <br /> 3. Bus ID Page/HMMP Complete and Accurate 19. 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? I 11. Hazardous Materials Being Properly Handled by Employees <br /> 5. Material Safety Data Sheets(MSDS) On Site 112.Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 113. Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explained in this section) <br /> 7L9 i e <br /> � � . ' ( c✓ c if <br /> r <br /> REFERRALS ❑SJ Ag ❑ SJ Env Hlth ❑OSHA ❑Fire ❑DA 0- <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 /> Busies Representative(Print Name and Title) Business Representative(Signature) <br /> -/Crmrr► Gt/i / ori �dmir�islru�ref�st /.�/„�.�o�� <br /> Name of Inspector Agen y Fire Co. (If Appro riate) WHITE COPY: OES�/ I PINK COPY: BUSINESS REV 9/02 <br />