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*J .2 COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 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 /> BUS SS NAME TELEPHONE NUMBER <br /> tPl S die -0 -711& 1 <br /> BUSINESS ADDRESS(Facility Being Inspected /57,& <br /> N <br /> 3.2 os- 2� /�Q�uw 2 , cJYo C-07' <br /> 95 9 <br /> FIRE D STRICT INSPECTION DATE ARRIVAL TIMEDEPARTURE TIME INSPECTION TYPE <br /> /O;0,9 GD; 9$— 11;&� <br /> relo <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 <br /> are Hazardous Waste Manifests On Site? /V 11.Hazardous Materials Being Properly Handled by Employees - <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 /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑ OSHA ❑ Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name an Business R presentative(Signature) <br /> �4elee/) dAbVq L}PA&-al Inovi Q <br /> Nam I Spector n Agency ^ Fire Co. (If Appropriate) WHITE COPY: OPS REV 9/02 <br /> 71OZ/- JZt.�LO fu-. ✓� [ - PINK COPY: BUSINESS <br />