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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 DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BU INESS NAME TELEPHONE NUMBER <br /> CL - � --.7oel/ <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> S- Z <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TlMt DEPARTURE TIME INSPECTION TYPE <br /> 00-odbei4 ,c _j72_,_7Z0 S— I A 0 f—0 1 <br /> tj INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site Y 17.Facility Map Complete and Accurate <br /> 2. HMMP[Map Easily Accessible to Employees 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/HMMP Complete and Accurate 19. 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? /IV 11.Hazardous Materials Being Properly Handled by Employee <br /> 5. Material Safety Data Sheets (MSDS) On Site 112.Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand IA-1 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <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 /> I.CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> -iusiness Representative(Print Name and Title) I Business Representative(Signature) <br /> �Oevpl !G / &-, P C4/h/;_j -,5-/2/-. J-7-tol,�-I­'tt. CZi1•GrE V r <br /> Nam f spector j Agency Fire Co.(If Appropriate) WHITE COPY: OES <br /> PINK COPY: BUSINESS I REV 9/02 <br />