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dy�r� <br /> Aft <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES 711IE❑ <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 D E C —2 2003 <br /> L HAZARDOUS MATERIALS DIVISION(209)468-3969fN GUuIY <br /> 1 FAX(209)944-9015 HRMOFBOGENCYSERIVAI E <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> FIRE DISTRICT INSPECTION DATE IA!RRIVAL)TIME DEPARTURE TIME INSPECTION TYPE <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES N FACILITY INSPECTION YES NO <br /> 1. Business HMMPIInventory On Site 17.Facility Map Complete and Accurate <br /> 2.HMMPIMap 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, 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 (MEDS)On Site 112.Hazardous Materials Properly Stored and 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 /> Cao vi'm IeF_ \e . <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Mustpe Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Bu mess Represe''niitative(Print ame,a Title) B in ess Representative( ignature) <br /> - <br /> 1 <br /> Name o_ Inspector gency Fire Co. (If Appropriate) WHITE COPYJ OES <br /> *� PINI{COPY: USINESS REV 910 <br />