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A <br /> 10 COUNTY OF SAN JOAQUI <br /> OFFICE OF EMERGENCY SERVICES <br /> � ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> z. STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> - FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINNEESS NAME //�� TELEPHONpE NUMBER <br /> aaktr I-oo r "2 —O { 7 / <br /> BUSINESS ADD SS (Facility Bein spected) <br /> 340 k—f •2u'- <br /> FIRE ISTRICT INSPEC ION D T ARRIVAL TIME DEP TURE TIME INSPECTu IN TY�E <br /> S H 2S� BJ 32a `f Ofl eri f,°ca77 <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 S.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/HMM[P 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 Employees <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) 1 / <br /> Ae– <br /> .Si .'I r,SS- <br /> oo '� <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Acti ns Mus be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> 2 ZG'o <br /> ACKNOWL DGE ENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Bus me"' epresentative(Signature) <br /> /3 Ili kjuj 7, e-A&A 62 . k Z aizo <br /> Name I ec or Agency Fi Co. (If Appropriate) WHITE COPY: OES <br /> PINK COPY: BUSINESS REV 9/02 <br />