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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> 4 STOCKTON, CALIFORNIA 95202 <br /> 14b4f� HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> .-� - FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> ��o e5^087 <br /> a <br /> BUS ADDRESS(Facil Being Inspected) _ <br /> e- k1tqCA <br /> 5 <br /> DISTRICT INS CTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTI�OIN TYPE <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1.Business HIvMP/Inventory On Site L47.Facility Map Complete and Accurate <br /> 2.HMMP/Map Easily Accessible to Employees 18.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 12.Hazardous Materials Properly Stared and Labeled <br /> 6.Current Training Records On Hand 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explain ed in this section) <br /> 4- -4L- <br /> C O <br /> If -`-s_ <br /> .1.4aU R / <br /> f <br /> >EXPRESS <br /> Larry Toone Fax(209)460-0876 <br /> P.O.Box 30785 Office(209)460-0877 <br /> Stockton CA 95213-0785 Dispatch 1-888-524-8279 <br /> Email: larry@jag-express.com <br /> REFERRALS ❑S"9 ❑SJ Env HIth ❑OSHA 0 Fire <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 Representative(Print Name and Title) Business Repre alive(Signature) <br /> Name o Ins for / Ag y Fire Co f Appropriate) COPY: OPS REV 9/Q <br /> �$ IN �� PINK COPY: BUSINESS <br />