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Ah <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ,. ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> i STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> _ FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BTSNAME TELEPHONE NUMBER <br /> 9 P-00PV <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> " wqO E <br /> FIRE DISTRICT IN$PECTIONI5ATE ARRIVAL TIME DEPARTURE TIME JINSPECTIONTYPF <br /> 0 <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1.Business HMMP/Inventory On Site V.,T 7.Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employee 8.Chemical Inventory Complete and Accurate I/ <br /> 3.Bus ID Page/HMMP Complete and Accurate V 9. Employees Familiar with HMMP 1/ <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 Employees <br /> 5. Material Safety Data Sheets (MSDS) On Site 12.Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 3. Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO" above must be explained in this section) <br /> S- O ih In . ./ - s <br /> 1 ;n t/if a CO a - -� <br /> S' <br /> JL/4E,4 7L P7 j0 to <br /> aC; QvtJ , t C3A2 cz 0 2a4a <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑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 /> Z fo 2� <br /> ACKNOW!4DGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> ar v <br /> Name of In pector gency Fire Co. ( p opriate) WHITE COPY: OES <br /> PINK COPY: BUSINESS REV 9/02 <br />