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qG,N COUNTY OF SAN JOAQUIN ftd <br /> �Gs. ........c <br /> . � .o� OFFICE OF EMERGENCY SERVICES <br /> _' Z ROOM 610,COURTHOUSE <br /> a 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> BUS. (209)468-3969 FAX(209)9449015 <br /> 'tC%FO Ra`' <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS S NAME �- TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIPCODE <br /> 303 Ir L ads ( 9SC7 <br /> FIRE DIS ICT INSPECTION DATE ARRIVALTIME DEPARTURE TIME INSPECr10N TYPE <br /> 6-a7-0a /`/.' 00 A / Y : 3-"A- <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 113. 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 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 /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Busine s Representative(Print Na a Ti )and /_ moo, k-an;.( Busin e t ive(Signatu <br /> /p wP�r~1 fi - G <br /> Name o Inspector and Fi Company WHITE COPY: OES <br /> A �� CANARY COPY: FIRE PREVENTION REV I I/96 <br /> PINK COPY: BUSINESS <br /> GES-HMI t&OO) <br />