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COUNTY OF SAN JOAQUIN RECEIVED <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE JUN 16 20 <br /> 222 EAST WEBER AVENUE <br /> SA <br /> N JOAQUIN COUNTY <br /> STOCKTON, CALIFORNIA 95202 <br /> OFFICE OFEMERGENCY SERVIC S <br /> MS' HAZARDOU FAX(209)944-901 ION(209)468-3969 <br /> HAZARDOUS MATERIALS PR NSPECTION FORM <br /> BUSINESS NAMEA TELEPHONE NUMBER <br /> ✓tom a-,t UIA P- f� �! l— O I <br /> BUSINESS ADDRESS (Facility Being Inspected) , <br /> 70o-7 L�Z <br /> FIRE DISTRICT INSPECTION DATE IVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> V-05- ARRtom. I vt_Q. <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NC,1 FACILITY INSPECTION YES ANO <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, R 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 42.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) J� <br /> -44- 1 <br /> � � r <br /> ej xt <br /> cta„ a1N-Rm <br /> o� <br /> /fid ES - 2 y-o S <br /> T�a.w, N-Ha <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 /> 6- z y-os <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECT RESULTS <br /> Busine epr sentative(Pri Name and Title) Zu <br /> es Re r �v ) <br /> A� 5CIA <br /> Name of Ins or Agen�3'STC <br /> 1 Fire Cojff Appropriate WHITE COPY: OES <br /> r/ D PINKCOPY: BUSINESSV 9/02 <br />