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COUNTY OF SAN JOAQUINII� <br /> a^4�IN• c OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> • .., P BUS. (209)468-3969 FAX(209)944-9015 <br /> ,�%FCYRa HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS SNAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility Being Inspecttgd) ZIP CODE <br /> 6/1l U/1 f w 9,So�G <br /> FIRE STRICT' WSPECI'IO DATE ARRIVM TIME DEPARTURETIME INSPECTION TYPE <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 t 3. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> efdOL7\A,4 <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag []SJ Env Hlth OSHA Fire El <br /> Air Dist <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must Be Delivered To CIES 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) I Business Representative(Signature) <br /> L Q� <br /> Name/of Irlspector and Fir�eJ o'm/pan WHITE COPY: OES <br /> CANARY COPY: FIRE PREV <br /> ENTION <br /> �GU�✓� PINK COPY: BUSINESS REV I I/96 <br /> OES-HM1 (SM) <br />