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14.4 <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> J• �.� 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 /> BUSINESS NAME TELEPHONE NUMBER <br /> /I�Ic/�o c��t li✓'1 oa- e2 41"_2 9S�osDe2 <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> o2r//S !�/r�lasuue/ Gr, �'t/�el •� 4K 9s5, 5F <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> 3 —,o,I— D9.'/.C— Of:27 /CC�tGtl�f2 <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 18.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, N/ 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site? 11.Hazardous Materials Being Property Handled by Employee <br /> 5.Material Safety Data Sheets (MSDS) On Site 112.Hazardous Materials Properly Stored and Labeled V <br /> 6.Current Training Records On Hand 3.Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explained in this section) <br /> sr V&-�X <br /> REFERRALS ❑SJ Ag ❑SJ Env HIth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Delivered to OES ByFollow Up Inspection Date OES Inspector Name Performing Follow Up <br /> 13- O's-, <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) ness Representative(Signature) <br /> Busi <br /> Name o Inspector nr�r" Agency Fire Co.(If Appropriate) ITE COPY: OES <br /> .¢e!P Juq/-O Lam-.7� - PINKCOPY: BUSINESS REV 9/02 <br />