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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> =s � 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> aIj HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME <br /> TELEPHONE NUMBER <br /> J{i, <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> FIRE DIST/DICT / INSPECTION DATE ARRIVAL TIME DEPARTUREJINrS/7ECTITIME N TYPE <br /> g7 <br /> Gc `/O <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site Fity Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employee ical Inventory Complete and Accurate <br /> 3.Bus ID Page/HMMP Complete and Accurate loyees Familiar with HMMP <br /> 4. If Business is a Hazardous Waste Generator, t Operations Appear Safe j <br /> are Hazardous Waste Manifests On Site? ardous Materials Being Properly Handled by Employee <br /> 5. Material Safety Data Sheets (MSDS) On Site 12.Hazardous Materials Properly Stored rand Labeled <br /> 6. Current Training Records On Hand 113. Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explained in this section) <br /> �.-of ct T ,' i <br /> —2- <br /> o e <br /> ,r <br /> a� <br /> i <br /> :Ft ' <br /> REFERRALS ❑SJ Ag ❑SJ Env HIth ❑OSHA ❑Fire ❑DA, ❑ <br /> INSPECTION FOLLOW UP INFORMATION 4, <br /> Corrective Actions Must be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> j� <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RFSULTS ' <br /> $ ' ess Representative(Print Name and T' Bu ' Rep entative(S' ' atur <br /> Name of Ids ctor Agency Fire Co. (I Appropriate) WHITE COPY: OES <br /> PINK COPY: BUSINESS REV 9/0 <br />