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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> � ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNI 027- <br /> HAZARDOUS MATERIALS DIVIS (209)468-399 ,,,y���q \f.�.�S <br /> FAX(209)944-901 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME 1INSPECTIONTYPE <br /> 4a A Jo 00 <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site 7.Facility Map Complete and Accurate <br /> 2. HMW/Map Easily Accessible to Employees 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/HIvIMP 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 /> w� <br /> too I <br /> REFERRALS ❑SJ Ag ❑Si Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective ctions Must be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> AC� ua <br /> EWII,,EDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Re tative(Signal <br /> Nameo Inspector Agency FireJ/ Approp ate)WHITE COPY: OES REV 9/0 <br /> —. - PINK COPY: BUSINESS <br /> - i <br />