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COUNTY OF SAN <br /> <br /> <br /> <br /> ROOM 610,COURTHOUSE <br /> uf• < <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> ` 9tT<QRfi\p HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> -- FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSI SS NAME TELEPHONE NUMBER <br /> l *w Hmla OvL*w <br /> BUSINE ADDRESS (f7acility Being Inspected) <br /> FIRE DISTRICT INSPECTION D9rE ARRIVAL TIME DEPARTURE TIME INSPECTI N TYPE <br /> � INSPECTION RESULTS <br /> DOCUMENT REVIEW Y JS NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site X 7.Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees I X 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 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) <br /> fie., 1PP14 n <br /> Vs 4 t d <br /> QOU <br /> M <br /> 1alr_ uAh HP <br /> REFERRALS ❑SJ Ag ❑ SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> C ec 've Actions Must be Delivered to DES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> an <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Repres (Signature) <br /> NaTo � Agency Fire Co. (If Appro iate) WHITE COPY: OES REV 9/02 <br /> i S PINK COPY: BUSINESS <br />