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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(209) DIVISION(209)468-3969 <br /> FAX44-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINES TELEPHONE NUMBER <br /> s A y o� 6 �-S7P6 <br /> BUSINESS ADDRESSgac'lity Being Ins ected) <br /> zoV <br /> FIRE DISTRICT IN EC N ATE ARRIVAL TIME DEPARTURE TIME INSPECTI N TYPE <br /> 6-12-1l O -f /r/O /.5.r� �C/:¢I c ie.. <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO I FACILITY INSPECTION YES NO <br /> 1.Business HMMP/Inventory On Site V 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/BNMT 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 Employe <br /> 5. Material Safety Data Sheets (MSDS)On Site 12.Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 1 1 113.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) <br /> L7 1C <br /> 5— µco i <br /> LJ O <br /> t ati /-;_ <br /> A4 1h is oc-.--�,I iooi c E / 97S- <br /> REFERRALS ❑SJ Ag ❑SJ Env Eth ❑OSHA ❑Fire [IDA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representativeint Name and Title) Business Representative(Signatur <br /> Nam Inspector Age cy Fire Co. If Appropriate) WrffrE COPY: OES <br /> b e O I PINK COPY: BUSU40S V 9/0 <br />