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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> l 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 /> BUSINESS NAW,, TELEPHONE NUMBER <br /> Ma K`rr <br /> BUSINESS ADDRESS(FacilityBeing Inspected) <br /> 25-17— Lor -F a l2. <br /> FIRE DISTRICT INSPECTIO DATE ARRIVAL TIME DEPARTURE TIME INSSPECTION TYPE <br /> MaVtiGC 1 N —Z� l "l as (�'TC/ 6vt'6ty <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.H DAP/Map Easily Accessible to Employees 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/HIVIMP Complete and Accurate 9. Employees Familiar with HMMP <br /> 4.If Business is a Hazardous Waste Generator, <br /> �� 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 I X 113.Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explained in this section) <br /> J � l <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Delivered to OES ByFollow Up Inspection Date OES Inspector Name Performing Follow Up <br /> --)-G - �7 <br /> ACKNO EDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RE <br /> Business Representative(Print Name and Title) <br /> B R esen five(Signature) <br /> Name oFInspector Agency Fire Co.(If Appropriate) WHITE COPY: OES <br /> C PINKCOPY: BUSINESS REV 9/02 <br />