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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> `. 222 EAST WEBER AVENUE <br /> .+C STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> q_ix "6-✓- S�(oo,d 6'77 <br /> BUSINESS DRESS(Facility lBeing Inspected) <br /> 379 k S. 4s' 2_is— <br /> FIRE DISTRICT JINSPEICTION DATE ARRIVAL TIME DEPARTURE TIME I/N�SPEC ON TYPE <br /> e. a �e 2! Of //20 / ��J 1�2�'; 'C4 ' <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES O FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site Ll 7.Facility Map Complete and Accurate <br /> 2. HMW[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, 0.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 113. Soil and Facility Appear Non-Contaminated <br /> CO EN S (Items marked"NO"above must be explained in this section) <br /> 0 <br /> //2 Al <br /> �+-/G oisS e <br /> D Cr �o.+ O /J— a t► i rc Z i t Q a S ex- go, /. 06..Kr ccc c <br /> X C 4 Bh ?�2 /VtO O /r <br /> m e—ACA .Q es— <br /> REFERRALS <br /> fREFERRALS ❑SJ Ag ❑SJ Env 111th ❑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 RES TS <br /> Business Representative(Print Name and Title) Busines epresseenttaattiive(Signature) <br /> z/t v nC7 <br /> Nam f I pector A ncy re Co. (If Appropriate) WHITE COPY: OES <br /> �,,� t Q PINK COPY: BUSINESS I REV 9/02 <br />