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✓� a <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 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 NAME TELEPHONE NUMBER <br /> 44J- Z9s 2- <br /> BUSINESS ADDRESS(Facili Being Inspected) 1 .i <br /> 2 ZS O s T - `3QS— <br /> FIRE D TRICT INSP TION ATE AL TIME DEPARTURE TIME 12!1PECTI N TYPE <br /> cS (o S22in /ias�c <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 C., 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 /> N <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 /> & F' - A CIO' <br /> .`I 41j'CL a C14 ci_ � <br /> REFERRALS ❑SJ Ag ❑SJ Env Nth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Delivered to OES ByFollow Up Inspection Date OES Inspector Name Performing Follow Up <br /> 7mot -e— /6Q 2D0(p <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Bu/siin/ess Representative(Print Name and Title) Business sentative( gnature) <br /> UT!<jsjll A Lt� 01-C, M67 <br /> N I Pector ,Agency Fire C Appropriate)I WHITE COPY: OES <br /> tZ PINK COPY: BUSINESS I REV 9/02 <br />