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l dUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 45 <� ROOM 610,COURTHOUSE <br /> S 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> r �: HAZARDOUS MATERIALS <br /> E (209) DIVISION(209)468-3969 <br /> FAX015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility <br /> O S. BeinnInspected) <br /> 1d <br /> FIRE DISTRICT INSPECTION DATE JARRIVALTIME DEPARTURE TIME 1INSPECTIONTYPE <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site 1 7.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 113.Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explained inthissection) /� <br /> e j :Zell /da/ !�/ -.'I- u. fP G. <br /> �,e <br /> r � <br /> OP W.Z1ta <br /> ° + <br /> MECANGruaslas24hrs.TuwSetvtces <br /> 1 $crvicio de <br /> Irma Y °;�1711oa <br /> 1 <br /> X209) $ <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA 2',1-252 <br /> INSPECTION FOLLOW UP INFORMATIONGAg5205 <br /> Corrective Actions Must be Delivered to OES By Follow Up Inspection _ e„C . Stockton, <br /> -a cit <br /> 620 S56Vltlson W y S <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION <br /> Business Representative(Print Name and Title) - Busin .,cpresentative Sig e) <br /> Na �IA <br /> �ns ector A Fire Co.(If Appropriate ITE COPY: OES <br /> /�p is �' ,�(' y PINK COPY: BUSINESS REV 9/02 <br />