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e, I Q_ Ck <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 'I ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> 9t F ORi!¢ HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> B SS NAME //e TELEPHONE NUMBER <br /> / C_2 J Ile — 7 <br /> BUSINESS ADDRESS (Facilit Being Inspeted) <br /> ✓ rvt s—Z6 <br /> FIRE DISTRICT INSPEC IO DA E ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> S �3 0 7 1SZ 0 !610 C� /<a� <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 & 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? 1A1 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 t 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked`NO"above must be explained in this section) / L <br /> 7'rI dC 2' /A�. f-.c awes ,2Ge.6. ✓ CcGG efJ'r /4 TO E'Lo+ E,I. <br /> 7L ao ' lidcJ d <br /> ted - P✓o✓,'qjCuvvCo /o e -94 1,t4c; coy dr. <br /> - u d l; i t <br /> C"A aC t <br /> REFERRALS ❑ SJ Ag ❑SJ Env 111th ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Correc 've Actio s Must be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> (�-YZDO 7 <br /> ACKN16WLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> G+ zR L PLIbLs yrs r'rlleS <br /> ame sp for Agency Fire Co.(If Appropriate) WHITE COPY: OPS <br /> "Z,Allz_rPINK COPY: BUSINESS I REV 9/02 <br />