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COUNTY OF SAN JOAQUIN <br /> rr+` 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 /> NA TELEPHONE NUMBER <br /> e . <br /> 32-0 <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> 'g. 14WLI 97 <br /> FIRE DISTRICT INSPECTION DATE rARRIVALTIM'EDEPARTURE TIME INS ECTION TYPE <br /> G <br /> 9 z oq( © 0 �S or✓-u <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 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? 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 /> C¢1yIMEN/TS (Items marked"NO"abov must be explained in this sectio ) <br /> 1 $4. <br /> a Sues Of �e,i N. f G �aM. (}t rt <br /> an A4 .CK a f 4, ce 4 er o/r 2 Ce / 4te " <br /> o ✓ a �a�. s� Q / �0o f r 200 <br /> o . vt � ✓ <br /> __ &Ld4Z IrliC, a a <br /> REFERRALS ❑SJ Ag ❑ SJ Env 111th ❑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 /> ,N, 9 , 13 zao <br /> ACKNOV&EDGEMENT OF R9VIEW RECEIPT OF INSPECTIO S <br /> Bysfness Representative 'nt Name and itlB sin resentative(Signature) <br /> MP <br /> Na nspector ge Fir o.(If Appropriate) WHITE COPY: OES <br /> /(jLO.O.9-49PINK COPY: BUSINESS REV 9/02 <br />