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COUNTY OF SAN JOAQUIN <br /> ' O1 OFFICE OF EMERGENCY SERVICES <br /> 2� vy ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> 11, <br /> STOCKTON, CALIFORNIA 95202 <br /> 211 . <br /> �* HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> TELEPHONE NUMBER <br /> BUSSI�NESS NAME L y (j qY ,7 4, ©C) <br /> VaL� 6rl ai ! C , rnt , <br /> BUSINESS ADDRESS (Facility Befog Inspected) q <br /> C �QQJ Lc as ✓'r2. 1 G� �.t L���` <br /> FIRE DISTRICT IN ECTION DATE ARRIVAL TIME DEPARTURE TIME I ECTION TYPE <br /> 'Z <br /> S•�y ��. z tr o 6 iS <br /> INSPECTION RESULTS YES NO <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION <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? 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 /> 10 a <br /> c — <br /> �20- <br /> • <br /> • <br /> • <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Delivered to(.)ES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print N e and Title) Busines Representati a Sig t e) <br /> Name In pector A ncy re Co. (If Appropriat COPY: OES <br /> Name/ <br /> PINK COPY: BUSINESS V 9/02 <br />