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COUNTY OF SAN JOAQUIN <br /> Q�puly,•c <br /> n �Q•.,o OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> w t <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSIIVESS NAME TELEPHONE NUMBER <br /> P <br /> BUSINESS ADDRESS(Facility Being Inspected) r ZIPCODE <br /> S p 9.520 (a <br /> FIRE DISTRICT INS ON ATE ARRIVAL DEPARTURE T[ME INSPECTION TYPE <br /> / Ve <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 X 112.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 1 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section)/ <br /> nar a c� r o e r d n o A <br /> r <br /> — Ado a v <br /> 04 .2ta pn 142 <br /> - Ire e 2- <br /> /2- <br /> /2 a -d — oc� <br /> Old, allJO <br /> REFERRALS (FOR OF.S USE ONLY) E1Sl Ag [—]SI Env Illth OSHA Fire ❑ Air Dist 0 <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 Representative(Signature) <br /> JtIDIO,� I • � fl <br /> Name A I spector and Fire p WHITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> -G PINK COPY: BUSINESS <br /> OESXMI 111IY8) <br />