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COUNTY OF SAN JOAQUIN <br /> P <br /> I OFFICE OF EMERGENCY SERVICES C <br /> ROOM 610,COURTHOUSE y (' Q > <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 /> BUSINESS NAME TELEPHONE NUMBER <br /> S.T L, t't.� b l c_ 1,9 ,- (J� 1 ' — �a;.eak CS 46 F 3o J7 <br /> BUSINESS ADDRESS(Facility Being Inspected) / <br /> 277.5 �i�/OG--�S 11-776. <br /> FIRE DISTRICT INSPE TION PATt ARRIV IME DEPARTURE TIME INSPECTION TYPE <br /> 3 2 0 ' 1 ©R o q f.S- <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site wl 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, AA 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site? All, T 11.Hazardous Materials Being Properly Handled by Employee <br /> 5. Material Safety Data Sheets (MSDS)On Site V 12. Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand W A 113.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must beexplained in this section) <br /> T �Z — /D-a- <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑ OSHA ❑ Fire [IDA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Delivered to OES By Follow Up Inspection Date Inspector Name Performing Follow Up <br /> t w .nom <br /> kCKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usinessRepresentative(Print Name and Title) Business Representative(Signature) <br /> N f Spector Akenct Fire Co. (If Appropriate) WHITE COPY: OFS <br /> sILLS PINKCOPY: BUSINESS REV 9/02 <br />