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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> M STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS SS NAME TELEPHONE NUM <br /> r'.P 0-alzl-,yrs 1� /03/ <br /> BUSINES ADDRESS (Faci 4 Being Inspected) <br /> /B/6" v f� fo.� Cf 9Sr�0 6 <br /> FIRE DISTRICT INSPECTION DATE JARRIVAL TIME DEPARTURE TIME INSPECTION TY <br /> 10- 9-03 /000 ,�y fu.� <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES <br /> 1. Business HMMP/Inventory On Site 7.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, 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 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 /> 'tae �Gf� ➢�� GOA/d'-o <br /> REFERRALS ❑SJ Ag ❑SJ Env Mth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Delivered to OES By Follow Up Inspection Date DES Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Repres Signature) <br /> Name o Inspector ge Fire Co. (If Appropriate) WHITE COPY: OES <br /> �'�S' PINK COPY: BUSIIVESS REV 9/0 <br />