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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> F HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)9449015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> `�5�7-25FS 2 <br /> BUSINESS ADDRESS(Facility Being Inspected) 11 rr <br /> 2 2 9 S f e.Li o.,y *- �T �'-C O c���p.n 9S2_05- <br /> FIRE <br /> SZoSFIRE DISTRI ICITSPECTION DATE IVAL TIME DEPARTURE TIME JINSPECTIqN TYPE <br /> r9/1 <br /> 9 05 /3/S"- I /(/ S (/eP",Ff*C: <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1.Business HMMP/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/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 t 12.Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 1 113.Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explained in this section) <br /> ruvv+ r o '1` eE✓ ivl 04 S" ke <br /> 2'2 S-0 f-t-3 S <br /> REFERRALS ❑SJ Ag ❑SJ Env HIth ❑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(Pri t Name and Title) Business epresentativ (Signature) I <br /> rWA- LEE /cre -2 <br /> Nar=j of In tar A ency Fire Co. (If Appropriate) WHITE COPY: OES REV 9/0 <br /> `Ked,� p7 zZ O �` PINK COPY: BUSINESS <br />