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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 /> BU NESS NAME TELEPHONE NUMBER <br /> -;T . <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> FIRE DISTRICT 161SPETIO DATE JARRIVAL TIME DEPARTURE TIME ECTION TYPE <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1..Business HMMP/Inventory On Site .Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees 8.Chemical Inventory Complete and Accurate <br /> 3. Bus ID Page/HMMP Complete and Accurate T. 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? j 1.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 wl 13.Soil and Facility Appear Non-Contaminated <br /> COMMEN J(items marked"NO"above must be explained i this section) <br /> fL r;/4�a c1✓a /! <o / voo �vTJ�e✓ <br /> T io e- . k . �Qh 7L Q Ccc//Gi� Cn <br /> ir <br /> a,ccu � nq �. // <br /> c fcti <br /> ruw // un(< ae a d/�G nae <br /> 3� : <br /> /un�J'?4r v hien er O t <br /> jW <br /> II /L /3— �� �h <looQ o iu e- <br /> REFERRALS ❑SJ Ag SJ Env H1th ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP IN OR ATION <br /> Corrective Actio / Must be Delivered to OES By Follow p In peti Dale OE Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT90 INSPECTION RESULTS <br /> ess eq,esentative(Print Name and Title) urine tive Si <br /> �1� <br /> Name�6�Inspector Agenc Fire Co.(If Appropriate) WHTCE COPY: OFS <br /> /Cd PINK COPY: BUSINESS REV 9/02 <br />