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a <br />a <br />COUNTY OF SAN JOAQUIN <br />y 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 <br />VUrn (4 Al e MC4 <br />TELEPHONE NUMBER <br />BUSINESS ADDRESS (Facility Being Inspected) <br />C/ qR -C-lt> <br />FIRE DISTRICT <br />d'kk`r/� <br />INSPECTION DATE <br />JARRIVAL TIME <br />10 1 <br />DEPARTURE TIME <br />/� <br />1INSPECTIONTYPE <br />rn m <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br />1. Business HMMP/Inventory On Site <br />1 <br />17. Facility Map Complete and Accurate �jr• <br />2. HMMP/Map Easily Accessible to Employees <br />a1 <br />18. Chemical Inventory Complete and Accurate Y, <br />3. Bus ID Page/HMMP Complete and Accurate <br />X <br />19. Employees Familiar with HMMP <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site? <br />'I` <br />OI <br />10. Plant Operations Appear Safe <br />11. Hazardous Materials Being Properly Handled by Employees <br />5. Material Safety Data Sheets (MSDS) On Site <br />12. Hazardous Materials Properly Stored and Labeled <br />6. Current Training Records On Hand <br />12< 113. <br />Soil and Facility Appear Non -Contaminated <br />COMMENTS (Itejjms marked `NO" above must be explained in this section) <br />�- WR12 1"s el�ri"tiIor;. <br />REFERRALS ❑ SJ Ag ❑ SJ Env Hlth ❑ OSHA ❑ Fire ❑ DA ❑ <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions ?just be Delivered to OES By <br />Follow Up Inspection Date <br />OES Inspector Name Performing Follow Up <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Bu ' e 7egresent ve (Print Name and Ile) <br />V 4 ti 0,ru,•r % e K_ �Pt ru t o N <br />Bu ' ess Re tali. Sig <br />Name of Inspector gene Fir,9,96. ( ppro r' e) <br />47 <br />WHITE COP <br />I PINK COPY: BUSINESS <br />I REV 9102 <br />