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COUNTY OF SAN JOAQUIN <br /> ° OFFICE OF EMERGENCY SERVICES <br /> 1 ;t� ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> ` STOCKTON, CALIFORNIA 95202 <br /> ,fi F :' HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME �I TELEPHONE NUMBER <br /> V eV1 c-rx C4 L Cc <br /> BUSINESS ADDRESS(Facility Beingnspected) <br /> 30 Cert �a L __7�J <br /> FIyR�,E DIST/�tICT INSPECTION DATE ARRR�IVAL TIME DEEP/ART7URE TIME INSPECTION TYPE <br /> Pq in <br /> ceq <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/HMMP Complete and Accurate 9. Employees Familiar with HMMP <br /> 4.If Business is a Hazardous Waste Generator, 10.Plant Operations Appear Safe 2!� <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 I X 1 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) <br /> Z CO' YYl0.d wr c ti /�, <br /> d <br /> wrvL m Naw 19C4., A565�� <br /> ct f ✓I .n <br /> REFERRALS ❑SJ Ag ❑ SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Mu4t be Deliverg�to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> r 'cT <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usiness Repr se//nta/tfive(Print Name and Title) B ep tative(Si ature) <br /> 22 (�Z /_F :* <br /> Name of Inspector YK n A ency- Fire Co.(If App priate) WHITE COPY: OES <br /> /' l PINK COPY: BUSINESS I REV 9/02 <br />