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gu1N <br /> COUNTY OF SAN JOAQUIN <br /> a° •�o� OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> ;Fdaa TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> E/4R-TH k ` c . gg- of YG- o-r <br /> BUSINESS ADDRESS(Facility.Being Inspected) DP CODE <br /> 2 G s-I s A r2Pcy�7- w n r <br /> FIRE DISTRICT INSPECTION DATE ARRTVALTTME DEPARTURETIME INSPECTION TYPE <br /> P L - d o D o <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1. Business HMMP/Inventory On Site A 1 7. Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees X 8. Chemical Inventory Complete&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.Materials Being Properly Handled x <br /> 5.Material Safety Data Sheets (MSDS)On Site 12.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 /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag ❑SJ Env Hlth ❑OSHA Fire ❑Air Dist <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(Print Name and Title) Business rese t S. nature) <br /> ID©K) A Ql-CQL. bu . L• <br /> Name of Inspector and Fire Company WHITE COPY: OES <br /> L GQ��jj CANARY COPY: FIRE PREVENTION REV 11/96 <br /> 2C7 R/ CA( PINK COPY: BUSINESS <br /> OES HM 1(11 8) <br />