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PA�,H COUNTY OF SAN JOAQUIN n <br /> .- <br /> �2 <br /> °o OFFICE OF EMERGENCY SERVICES 7 <br /> a` ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE JUL 6. ,�,�,� <br /> STOCKTON,CALIFORNIA 95202 W '�=' ' <br /> ••�{��FORH`'• TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> IJ.E <br /> BUSINESS RIM(Facil Being JL Inspect ZIPCODE r� z <br /> FIREDISTRICI' INSPECI'I ND TE ARRIVAL DEPAR IN P O TYPE <br /> S� g tl M <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 x <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 /> 3 3g 3 38 <br /> D <br /> IV <br /> & 11� <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag SJ Env Filth OSHA Fire Air Dist <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective <br /> pActions Yost Be Delivered To OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> (O <br /> ACKNOWfEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> _ A <br /> f Inspector and Fire Company WHITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11196 <br /> C!Z J l PINK COPY: BUSINESS <br /> OES-HM 1(111% <br />