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1 <br /> COUNTY OF SAN JOAQUIN <br /> / OFFICE OF EMERGENCY SERVICES <br /> E ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> ._ FAX(209)9449015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE BER <br /> {2 <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> 2250 S f- )n-v s . S 9S-ZoS` <br /> FIRE DISTRICT INSPECT ON DATE JARRIVAL DEPAR TUTU E INSP l,%TYPE <br /> 5y� Al— <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES O FACILITY INSPECTION YES NO <br /> 1.Business HMMP/Inventory On Site 7.Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employee 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, Al, p 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site? A /T 11.Hazardous Materials Being Properly Handled by Employee <br /> 5.Material Safety Data Sheets(MSDS) On !!ice 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"aboplust be explained in this section) <br /> M[3SJAgJ Env MHUM0 OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> ConeGtyve Acti ns Mu be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> e <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(P . t Name and Title) BusinS4s Represe rTive(Signature) <br /> Name of Inspecto� gtgency Fire Co.(If Appropriate) WHi I E COPY: OPS V 9/0 <br /> ✓ (gyp "-' PINK COPY: BUSINESS <br />