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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 /> i HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> �.J a -1, I V6 �S'b7 <br /> BUSINESS ADDRESS(Facility ing Inspected) <br /> 0 96_';W(0 <br /> FIRE DISTRICT INSPE TION DATE ARRIVAL TIME EPARTURE TIME INSPECTION TYPE <br /> 1;4ps Ae F—U.14 CL '� o S / 0/S / 1 0 <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site oll 7.Facility Map Complete and Accurate <br /> 2.HMMP/Map Easily Accessible to mployee V .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 <br /> "NO"above must be explained in this section) f <br /> TT — S (h.v�.`III 1 0.l O -Z C. - O O l ,i (,�c o"kr c7 <br /> i l l T I �_ f <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corr 've Actiops Must be elivered to OES By Follow Up I tion Date OEs Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION ULTS <br /> Bu in ss Representati Print Name and Title) B sine i <br /> Name ofI specto- 40 Agen11Ccy Fire Co. (If Appropri te) COPY: OES REV 9/02 <br /> PINK COPY: BUSINESS <br />