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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> H ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> 'aY HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> �su�.H 2�•+ ✓ j2 G, Z----c 9�� <br /> BUSINESS AD SS (Facility Being Inspected) <br /> 7735 S ,�lw 99i o l� Cl <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME 1INSPECTIONTYPE <br /> � 2�cu�2 �ZO—off ZOr - //.'/J °`e� <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site 7.Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees \,'I 18.Chemical Inventory Complete and Accurate <br /> 3. Bus ID Page/HMMP Complete and Accurate .-1 19. Employees Familiar with HMMP ✓ <br /> 4.If Business is a Hazardous Waste Generator, f/ n10.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 12.Hazardous Materials Properly Stored and Labeled <br /> 6. Current Training Records On Hand 113. Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explained in this section) <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑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 RESULT <br /> Business Representative not Name and Title) Bus' ess Repre eNtati a S' nature) <br /> Nl C- �,aceR �c4\ <br /> Name o Ins ector n A nc n it Co.(If Appropriate) WHITE COPY: OES <br /> PINK COPY: BUSINESS I REV 9/02 <br />