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COUNTY OF SAN JOAQUIN <br /> -.a- 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 /> BU SS NAI TELEPHONE NUMBER <br /> BU INESS ADDRESS O (Facility B ing Inspecte <br /> ^ <br /> FjM DISTRI T INSP TION D ARRIVAL TIME IDEPARTURE/ /�/STIME PECTIO/N TYPE <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? vr 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 /> fit- — o 'at e ✓c-.-+- %� <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corre ivecations ust be GLV Delive r�e^d to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> r <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPBeTION RES TS <br /> us'nenRepre�sent i�int,Name and ' le) � Busi Represent (Sig tur <br /> X <br /> Name of Insp for Agency Fir o.(If Appropriate) WHITE COPY: OES <br /> ,� PINK COPY: BUSINESS REV 9/02 <br />