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pQM�N COUNTY OF SAN JOAQUI �~ <br /> OFFICE OF EMERGENCY SERVICES <br /> r: c <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> •�.., P.� STOCKTON,CALIFORNIA 95202 <br /> �O�FO PNS BUS. (209)468-3969 FAX(209)944-9015 <br /> BUSINESS NAME ��HHAZARRDOUS MATERIALS PROGRAM INSPECTION FORM <br /> �e" ' s 2•l)oPi7' TELEPHONENUMBER <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> .3sa a- S' - 9?93- SaIS- <br /> FIRE <br /> j�I TRICT �rQ�� ZJPCODE <br /> INSPECI'IONDATE ARRIVAL TIME <br /> V /O-a _U DEPARTURE TIME INSPECTION TYPE <br /> C)-,2- 4 %30 /00/ <br /> DOCUMENT REVIEW INSPECTION RESULTS � � <br /> 1. Business HMMP/Inventory On Site YES NO FACILITY WALK THROUGH <br /> 7. Facility Map Complete and Accurate YES NO <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, <br /> are Hazardous Waste Manifests On Site 10. Plant Operations Appear Safe <br /> N 11.Materials Being Properly Handled �- <br /> 5. Material Safety Data Sheets(MSDS)On Site <br /> Materials Properly Stored and Labeled <br /> 12. <br /> 6.Curren[Training Records On Hand <br /> COMMENTS (Items marked \/ 13. Soil and FacilityA <br /> "NO" above must be explained in this secti n) ppear Non-Contaminated <br /> 1�VASace <br /> ay Te <br /> �J BJP �Lur lvi�,iv7 a, n <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag E]SJ EnvHhh <br /> INSPECTION FOLLOW UP INFORMATION ❑OSHA Fire LJAir Dist <br /> orrective Actions Must Be Delivered To OES By Follow Up Inspection Date <br /> OES Inspector Name Performing Follow Up <br /> KNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> 1n@Ss Representative(Print Name and Title) <br /> <7 I��/ Business Repres1en�tative(Signature) <br /> e of Inspec or and Fire Company l 0 r G r e '�^ Q W <br /> HI COPY: OES <br /> �' v"��s-""/ /S'�,�1/2 CANARY COPY: FIRE PREVENTION REV I I/96 <br /> PINK COPY: BUSINESS <br /> OES-HM1 (9/00) <br />