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COUNTY OF SAN JOAQUIN <br /> {Q` OFFICE OF EMERGENCY SERVICES <br /> u5 ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> l F HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> n� d�I ✓ --? 3 40 <br /> BUSINESS ADDRESS(Facilr <br /> eing Inspected) v <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <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. HMMP/Map Easily Accessible to Employees 18.Chemical Inventory Complete and Accurate <br /> 3. Bus ID Page/HMMP Complete and Accurate 19. 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`? I 11. Hazardous Materials Being Properly Handled by Employee <br /> 5. Material Safety Data Sheets (MSDS) On Site 112. 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 /> \Aja <br /> >r� 06 �( <br /> � Gwv�,� � ►ice �� ��/�/ <br /> REFERRALS ❑ SJ Ag El SJ Env Hlth El OSHA El Fire ❑DA 1:1 <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 Repr entative(Print Name and Title) Business esCentative Signature) ^ <br /> Name of InspectorAgency Fire Co.(If Appropriate) WHITE COPY: OES <br /> t/� PINK COPY: BUSINESSREV 9/02 <br />