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' ". COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> t4 <br /> (� [ ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> "'fit i v phi' HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)9449015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS SS NAME K TELEPHONE NUMBER <br /> �t e <br /> c d7 <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> rte �T <br /> FIRE DISTRICT INSPECTION DATE JARRIVAL DEPARTURE TIME INSPECTION TYPE <br /> Tam lU-/4f�1- ( 0 It o1 im <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 EmployceE 8.Chemical Inventory Complete and Accurate ' <br /> 3.Bus ID Page/HMMP Complete and Accurate j9I 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 /> 1L <br /> COMMENTS(Items marked"NO"above must be explained in this section) <br /> 0\awv&lad of ` <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 /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Basinun�� <br /> AKUII. <br /> Name of Inspector /� . Agency Fire Co. (If Appro ria[e) WHITE COPY: OES <br /> a 7 1 PINK COPY: BUSINESS REV 9/02 <br />