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COUNTY OF SAN JOAQUIN <br /> o.^qu(y c OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> +; < 222 EAST WEBER AVENUE <br /> �t STOCKTON,CALIFORNIA 95202 <br /> BUS. (209)468-3969 FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS�S NAME TELEPHONE NUMBER <br /> ✓ua„ ,f �e a,r '/63 - div o <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 11115-S _h4- <br /> FIRE DISTRICT <br /> h4-FIREDISTRICT INSPECTION DATE ARRIVAL TIMEd DEPARTURETIME INSPECTION TYPE <br /> Q , �,p / . LING!GuP <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH 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&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 <br /> 5.Material Safety Data Sheets (MSDS)On Site 12.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items <br /> mark�ed�t"NO" above <br /> must bed explained in this section)) <br /> O <br /> ci co — af— o <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 /> g - (- 0,2- <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Busine Representative ignature) <br /> NIANyt Z, 411f (99f-la <br /> Nam of Inspector and Ire Company WHITE COP OES <br /> /96 <br /> �/_ CANARY COPY: FIRE PREVENTION REV I I <br /> �!/��1 JJ LGtrF-" Y �✓� PINK COPY: BUSINESS <br /> OES-NMI (9/00) <br />