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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> r` v <br /> .� ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> it STOCKTON, CALIFORNIA 95202 <br /> ,t.,. HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> / - ' FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Ja k ' + ` OP 953-2�s7 <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> r H 9S u1 <br /> FIRE DISTRICT SPECTION DATE ARRIVAL TIME DEPARTURE TIME 1INSPECTIONTYPE <br /> S16 c ��o�� 9/Z(o%� D 1510 f f wr,o <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site T 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 9. Employees Familiar with HMMP <br /> 4.If Business is a Hazardous Waste Generator, A.1 1410.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site? I 11.Hazardous Materials Being Properly Handled by Employee <br /> 5. Material Safety Data Sheets(MSDS) On Site V10 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 /> 1-4 <br /> 4C op Pro // nn <br /> eM 10 2 ¢t /�ar+. tJ6-f o C-4/c :+r <br /> 7 ly t,d J at i r n o .a.- l 4 AL, 4 4 L <br /> COIJ/ <br /> REFERRALS ❑SJ Ag ❑SJ Env FEth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Correctiv Actions Must be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> G W� <br /> ACKNOWLEDGEMEN OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(S nature) <br /> �N I1 <br /> am Ins ctor Age y FireCo. (If Appropriate) WHITE COPY: CIES <br /> PINK COPY: BUSINESS REV 9/0 <br />