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COUNTY OF SAN JOAQUIN <br /> '~ ° OFFICE OF EMERGENCY SERVICES <br /> (m ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> t" STOCKTON, CALIFORNIA 95202 <br /> �.iWi�eT!�' HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> P L S EE tI&-)43M, GReJ L L 4 <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> 2<o.s9 t✓ 10 .¢AeCAl ZAl. 55x_0 cTo,✓ Y-5r <br /> FIRE DISTRICT. INSPECTION DATE JARRIVALTIME DEPARTURE TIME INSPECTION TYPE <br /> ZZ <br /> 3 - F- 07 //.•ir AW/tli° <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? 11.Hazardous Materials Being Properly Handled by Employee <br /> 5. Material Safety Data Sheets (MSDS)On Site pe*' 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 /> (1) 0407-0 P 9) T W <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 AND RECEIPT OF INSPECTION RESULTS <br /> Business RepresentativeCPrint Name and Title) Bu ss Repre•ent rve( ignat e) <br /> j_ _/1/ O r G c.� G. A4. a n <br /> Nam of Inspector a Agency Fir .(If Appropriate) WHITE COPY: OES <br /> 20,/eLL /TLLr� OES PINK COPY: BUSINESS I REV 9/02 <br />