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Ah <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)9449015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> TELEPHONE NUMBER <br /> BUSINESS NAME <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> ZO <br /> FIRE DISTRICT SPECTION ATE ARRIVAL TIME DEPARTURE TIME INSPECTI/O�TYPE <br /> /� 29 0 ,7 09S_0 /0 Zo vee 't�C��o <br /> INSPECTION RESULTS YES NO <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION <br /> 1.Business HMMP/Inventory On Site7.Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employee 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 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 /> Ito e . . oe <br /> X — 79 c <br /> u a a7 2 - p I/16cr T (.Z <br /> J- <br /> 2 '9 Za o <br /> 3 / o <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective A 'ons M t be Delivered to OES By Follow Up Inspection Date O <br /> ,SES Inspector Name Performing Follow Up <br /> — yR Zvo <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Busines Representative(Print Name and Title) <br /> Busi ess epresenWive(Sign <br /> ame of Spector ge cy tire o. (If Appropriate) WHITE COPY: DES REV 9/02 <br /> PINK COPY: BUSINESS <br /> i <br />