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COUNTY OF SAN JOAQUIN P.:am-1 Z1IE® <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE MAY 12 2004 <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 '�yo/6°'f+u�+v2USTY <br /> ( ESR d NCY SERVIC <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)9449015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> SvW- c*r0.lo J <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> a°�EkP.5\ �,s . oe'\ <br /> FIRE DISTRICT INSPECTION DATE JARRIVAL TIME IDEPARTURETRIVIE 1INSPECTIONTYPE <br /> woos�w S O� 00�30 EWm? <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 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/IIMMP 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 /> REFERRALS ❑Si Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective ctions Must be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> S \.o <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Represe alive(Print Name d Title),L Business Repre to ve(Signature) <br /> o/Q <br /> Name of Inspector Agency Fire Co.(If p ropriate) WHITE COPY: OES - <br /> µS \Wh4'1N\ CaqN_ • PINK COPY: BUSINESS I REV 9/0 <br />