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COUNTY OF SAN JOAQ UIN <br /> olAutN <br /> a•' Q�oG OFFICE OF EMERGENCY SERVICES OCT ^ 61997 <br /> Z ROOM 610, COURTHOUSE <br /> r. <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> TELEPHONE(209)468-3969 <br /> t�FO'iR� <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM ^� <br /> BUSRNE SME / 6q0514-; S J <br /> BUSINESS ADDRESS(Facility Beinspec�o w d 0 �c�6 <br /> FIREDIS C' S INSPECTIONt DATE ARRIVAL TIME DEPARTCJRETTME INSP UON TYPE <br /> 11 . <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 t/ <br /> 2. HMMP/Map Easily Accessible to Employees 8. Chemical Inventory Complete&Accurate <br /> 3.Bus ID Page/HMMP Complete and Ace e 9. Employees Familiar with HMMP <br /> 4.If Business is a Hazardous Waste Genera //, 10. Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site 11.Materials Being Properly Handled 1/111 <br /> 5.Material Safety Data Sheets (MSDS)On Site 12.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand t/ 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" ab ust be explained in this section) <br /> as <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 /> Bus i epresentative(Print Naw a Title) Business Representative(Signature) <br /> ame of Inspector and Fire Company �� t/ WHITE COPY: OES <br /> nnC �r7Uo CANARY COPY: FIRE PREVENTION REV 11/96 <br /> I " ��`V PINK COPY: BUSINESS <br /> OES-HM1(1 iM) <br />