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• <br /> w COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> �jt ROOM 610,COURTHOUSE <br /> 1i 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 NAME TELEPHONE NUMBER <br /> • g. . 1 9414 : 3 0 <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> FIRE <br /> /D�ISTR CIN <br /> T SP ION DATE ARRIVAL DEPARTURE TIME INSS�PECTION TYPE <br /> Ale F 2 p <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 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 /> Q C'o v✓� s o e__ <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 /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usiness R resentative(Prtt(�i��Iame and Title) <br /> Business se tiv e <br /> Gid / I^ c P /r � 2 4Xl/C4 <br /> 'F47X In ector Agenc Fire o. <br /> PINK COPY: BUSINESS 9/02 <br />