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ih 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 /> w . <br /> ..i F <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> CJaI a d Yht„r d_ <br /> BUSINESS' ,A/D(DIRES (Facilit BeingInspected) <br /> K a cr <br /> FIRE DISTRICT INS ECTION DATE ARRIVAL T DEPARTURE TIME INPECTION TYPE <br /> or <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site -61 17.Facility Map Complete and Accurate <br /> 2. HMMPIMap Easily Accessible to Employees 8. Chemical Inventory Complete and Accurate <br /> 3. Bus ID Page/HMMP Complete and Accurate 71' 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 explained in this section) <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 RECE7 OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Represents K e(Si ure <br /> S BI A � <br /> ame of InspectorAgency Fire Co. Ap ropriate) WHITE COPY: OES <br /> t PINK COPY: BUSINESS REV 9/0 <br /> A( <br />