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0 <br /> COUNTY OF SAN JOAQUINk <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)9449015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> 704 - <br /> BUSINESS ADDRESS facility Being Inspected) <br /> o l wt 0VA V . S c_O-orn 9Sz-1 <br /> FIRE DI TRICT INSPEC IONTE ARRIVAL T JDE�g TURF TIME JINSPECTIONTYPE <br /> -am .2 4 4 0 12 5 Z ,,fo cH kLING INSPECTION R SULT <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 LX 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/HAIMP 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 /> QL�Isf LTJ✓'� /rs� <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 OES Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representa 've(Print Name and Title) Business Representative i <br /> L-�� - ( �, Gil <br /> Name sp or Agency p Fire Co. (If Appropriate WHITE COPY: ES <br /> PINK COPY: BUSINESS REV 9/02 <br />