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�1.. <br /> 104 <br /> 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 /> BUSINESS NAME 1� TELEPHONE NUMBER <br /> r1 <br /> BUSINESS ADDRES (Facilit Bei Inspected <br /> q <br /> FIRE DISTRICT INSPECTION DATE ARRIV"A�,,,,L��TIME DEPART TIME 1INSPECTIONTYPE <br /> CI+ �1 a n�C 7 15 —C.6 vV W141 LW <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site D 17.Facility Map Complete and Accurate N <br /> 2. HMMP/Map Easily Accessible to Employees 8.Chemical Inventory Complete and Accurate Al <br /> 3.Bus ID Page/HMMP Complete and Accurate 9. Employees Familiar with HMMP 16- <br /> 4.If Business is a Hazardous Waste Generator, 10. Plant Operations Appear Safe d' <br /> are Hazardous Waste Manifests On Site? 11.Hazardous Materials Being Properly Handled by Employee Zf <br /> 5. Material Safety Data Sheets (MSDS)On Site 112.Hazardous Materials Properly Stored and Labeled Ir <br /> 6.Current Training Records On Hand IT 113.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) 1 <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Deliv,wed to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> 2 -G <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF~UtTION RESULTS <br /> B ess Representative(Print Name ande) Business Representative(Signature) <br /> Name of Inspector AgAley Fire Co. (If Appropriate) WHITE COPY: OES <br /> PINK COPY: BUSINESS REV 9/02 <br />