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COUNTY OF SAN JOAQUIN RECEIVED <br /> OFFICE OF EMERGENCY SERVICES MAR 14 20 <br /> ,. ROOM 610,COURTHOUSE SAN JOAQUIN COUNTY <br /> 222 EAST WEBER AVENUE OFFICE OF EMERGENCY SERV ES <br /> STOCKTON, CALIFORNIA 95202 <br /> d `tr HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> t r� FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPH NE NUMBS <br /> BUSINESS ADDRESS(Facility Being Inspected) o� <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> I / - C <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW ES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site 1 1 17.Facility Map Complete and Accurate V <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 <br /> 74, <br /> are Hazardous Waste Manifests On Site? V 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 /> u <br /> i <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Delivered to UES ByFollow Up Inspection Date OES Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RE ULTS <br /> Buprese Live int Name and Title) usin s e( ure <br /> xt�L7; <br /> Ne of Insp tot Agency Fir o. (If Appropriat OPY: OPS <br /> PINK COPY: BUSINESS REV 9/02 <br />