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A,,,y COUNTY OF SAN JOAQUIN <br /> I° �o� OFFICE OF EMERGENCY SERVICES <br /> r` ROOM 610, COURTHOUSE <br /> ' ` 222 EAST WEBER AVENUE <br /> r STOCKTON, CALIFORNIA 95202 <br /> 6;CIFpRN�' TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSIN M <br /> AM TELEPHONE NUMBER <br /> BUSINESS ADDR S(Facility ei Inspected) CO <br /> FIRE I TRICE INSPE O DA ARRIVALTTME DEPARTURE TIME INSP ON <br /> S /0. 00 !O/ �' (/� ' c4 0 <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 1 113. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> XL% 044 01 a 0 /. elO Z <br /> 2 / <br /> t ¢ l Q r herq <br /> � J t <br /> 6 f <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag ❑SJ Env Hlth F]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 /> Busess Representative jPfint Name and Title) j Business Representative(Sig ure) <br /> Namelff I an Ire ompanvr WHITE <br /> CAN RCOP RE PREVENTIO <br /> PINK CO : BUSINESS V 1 6 <br /> OES-NM t(t 1M) <br />