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COUNTY OF SAN JOAQUIN 7 <br />OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE AUG 2 4 2004 <br />222 EAST WEBER AVENUE <br />STOCKTON, CALIFORNIA 95202 Sall JUPVUIN UVuN l if <br />.r F'riFGs-�v;'sF.u�NLt' Get it <br />HAZARDOUS MATERI N (209) 468-3969 <br />(209) 944-901 <br />HAZARDOUS MATERIALS P AM INSPECTION FORM <br />$�tSINESS NAME <br />$ 1 <br />TELEPHONE NUMBER <br />BUSINESS ADDRESS (Facility Being nspected) <br /><Ss33 9 <br />FIRE DISTRICT <br />INSPECTI04 DATE <br />-ZO-0 <br />ARRIVAL TIME <br />1 1' <br />DEPARTURE TIME <br />1INSPECTIONTYPE <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br />1. Business HMMP/Inventory On Site <br />✓ <br />7. Facility Map Complete and Accurate ✓ <br />2. HMMP/Map Easily Accessible to Employees <br />8. Chemical Inventory Complete and Accurate ✓ <br />3. Bus ID Page/HMMP Complete and Accurate <br />9. Employees Familiar with HMMP ✓ <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site? <br />/ <br />V <br />10. Plant Operations Appear Safe <br />11. Hazardous Materials Being Properly Handled by Employee <br />5. Material Safety Data Sheets (MSDS) On Site <br />V/ <br />12. Hazardous Materials Properly Stored and Labeled <br />6. Current Training Records On Hand <br />✓ <br />13. Soil and Facility Appear Non-Contaminated <br />COMMENTS (Items marked "NO" above must be explained in this section) <br />I / 1 <br />b ' ` 4A"_5 <br />U'{/ <br />gl l <br />REFERRALS ❑ SJ Ag ❑ SJ Env Mth ❑ OSHA ❑ Fire ❑ DA ❑ <br />INSPECTION FOLLOW UP INFORMATION <br />Corr dive 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) Bus s Representative (Signatu ) <br />N e of n t r Agency Ire Co. (If Appropriate)WHITE COPY: OES REV 9/0 <br />O ui „ PINK COPY: BUSINESS <br />