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0 <br /> P :�,1M' COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ,N;.�} •t� 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 /> BUSINESS NAMETELEPHONE NUMBER <br /> ` ! I ou,- 5�75�-you <br /> BUSINESS ADDRESS(Facility Bein Inspected) / � <br /> S ?t L (J c TZ7v� 5 202 <br /> FIRE DISTRICT INSPE TI N DATE ARRIVAL TIME DEPARTURE TIME IN PECTION TYPE <br /> sficEast � f i?(t, 1 89945— 103-6— <br /> INSPECTION <br /> 03 INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site .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' <br /> A 10.Plant Operations Appear Safe <br /> r <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 /> Z - ods' 0 .w✓roled- 14-A 4 _,4 194 us 6 <br /> 4,1ol eQ..r,'44e ac eFX,El d NHr.a 00 <br /> V K <br /> (p ' ?•ro,ioa� c <br /> -0. of 1.Lt Wl O �- L <br /> REFERRALS ❑SJ Ag ❑ SJ Env Htth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corr ctive Ac ti ns Must be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> zoo(o <br /> ACK WLEDGEMBNT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> 6 v kr z-- <br /> Nam I pector / A nc Fire Co.(If Appropriate) WHITE COPY: OES <br /> E� ` 40 �— PINKCOPY: BUSINESS REV 9/02 <br />