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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ,� <1 ROOM 610,COURTHOUSE _ <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 �• �: <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> - FAX(209)944-901 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME , . ll TELEPHONE NUMBER <br /> BUSINESS ADDRESS (Facility eing)pspected) <br /> tars- w Rd <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECT ON TYPE <br /> ��j,�,ra�a <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES op NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site 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 Employees <br /> 5. Material Safety Data Sheets (MSDS) On Site Vk 112.Hazardous Materials Properly Stored and Labeled <br /> V11- <br /> 6. Current Training Records On Hand (i5V 113. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO"above must be explained in this section) <br /> ley <br /> Z� <br /> REFERRALS ❑ SJ Ag ❑ SJ Env Hlth ❑ 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 /> `-KNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION MSULTS <br /> .si e s Representati e(Print Name and Title) Vspeg ntative(Signature) <br /> e of In pec or Agency Fire Co.(If Appr riate) WHITE COPY: OES <br /> SJ PINK COPY: BUSINESS REV 9/02 <br /> C <br />