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COUNTY OF SAN JOAQUIN <br /> *444,ab_q"_ <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)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> U -FeoazeZ &'�& G, X093 x'73-D9o9 <br /> Ajr- <br /> BUSINESS ADDRESS(Facility Being Ins ppected) <br /> 770/ )6ie <br /> FIRE DISTRICT INSPECTION DATE JARRIVAL TIME DEPARTURE TIME 1INSPECTIONTYPE <br /> 0935 iso fiEs�ow `y <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMNIP/Inventory On Site v 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/HMI P Complete and Accurate 9. Employees Familiar with HMMP i — <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 Employees <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 /> C9 <br /> ng� <br /> /v0 tz-- ,^&- -"L <br /> REFERRALS ❑SJ Ag ❑ SJ Env 111th ❑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 /> /— a 9' 03 <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RE TS <br /> Business Representative(Print Name and Title) Busines epresentative(Signature) <br /> a P A 9-0 W 6 nT 1I SFA4 i R&- A (iU6 1 <br /> Nameof nspector nn"" ��,, Agency Fire Co. (If Appropriate) WHITE COPY: OES REV 9/02 <br /> /(iL�LLGI P JZUAo 7u+'(�-J✓2 le—f I PINK COPY: BUSINESS <br />