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mill <br /> i COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> � HAZARDOUS MATERIALS DIVISIOAI(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> C vi <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> fit d <br /> FIRE DISTRICT INSPECTION I3ATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> r 110 W 11( 0 H- Lille <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site '6 17.Facility Map Complete and Accurate <br /> 2. HMMPIMap Easily Accessible to Employees 18.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/HMMP Complete and Accurate 9. Employees Familiar with HMMP r7 <br /> 4.If Business is a Hazardous Waste Generator, 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site? r 11.Hazardous Materials Being Properly Handled by Employee <br /> 5. Material Safety Data Sheets (MSDS)On Site Y, 12.Hazardous Materials Properly Stored and Labeled <br /> 6. Current Training Records On Hand 113. Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explained in this section) <br /> tiV\- ,yl <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 Representative(Print ame and Ti(e) IBU ss Represe ive(Si nature) <br /> Name of Inspector A nc Fire Co. (If propriate) WHITE COPY: OES <br /> PINK COPY: BUSINESS REV 910 <br />