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Q COUNTY OF SAN JOAQUIN <br /> U IN <br /> �o .coG OFFICE OF EMERGENCY SERVICES <br /> ?� ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> TELEPHONE(209)468-3969 / � �J <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM T J <br /> BUSINESS NAME, TELEPHONE NUMBER <br /> 47 Y73,5- <br /> BUSINESS ADDRESS(Facility Being Inspect ) ZIP�CyODE <br /> X19 S. �u S/.. c_ / S'z� <br /> FIRE DIS CT IN SP N ATE ARRIVAL TIME DEPARTURE TIME INSP ON <br /> ,' T <br /> cQ�<` <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 marked "NO" above must be explained in this section) �f <br /> .Y SO C Q o o, 7- <br /> " X o <br /> e <br /> c n. <br /> REFERRALS (FOR OES USE ONLY) 1:1 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 /> ACOOWLEDGOMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Busin s r ti t Name and Title) 13 s Repres tat;ve(Sign re <br /> c� T <br /> Name of Inspector and Fire Company,-.--_-,? / <br /> TCANMARYOCTY-. OFIRE PREVENTION <br /> r� `^� Q NK COPY: BUSINESS REV 11/96 <br /> OES-HM 1(11/96) <br />