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WO COUNTY OF SAN JOAQUIN MW <br /> oP4� N 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)9449015 <br /> �/FON <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TEL NUMBER <br /> � 2v (b 9 101 c( <br /> BUSINESS A1LD�DRRE/ C-4l-SS(Faacility Being Inspected' <br /> y� ZIP CODE <br /> I`l '�L o- C/rt 1/ <br /> FIREDISTRICT INSPECTION ATE ARRIVALTIME DEPARTURE E INSPECFIONTYPE <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 p 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 marked "NO" above must be explained in this section) <br /> REFERRALS (FOR OES USE ONLY) [—]SJ Ag F]SJ Env Hlth OSHA [—] Fire [:]Air Dist Ej <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 /> Busin ss Representative Print Narpe and Title) Bus* ss Representativ (Signa re <br /> �j('enc. 4S�i //p Si'l'l ��� "' <br /> Name of Inspector and Fire Company WHITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> OES-HM1 (9100) <br />