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�IIV qCOUNTY OF SAN JOAQUIN <br /> a4' ' •� OFFICE OF EMERGENCY SERVICES <br /> r` % ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> BUS. (209)468-3969 FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> C��6& K re V79- is-a� <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> /L/6,7 Zel 9Sa2/0 <br /> FIREDTRICT INSPECTION DATEARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <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 .,i- 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 All 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) <br /> .*3 (Up6L a4e ee- Au&, fi i-s 1paee amt C ,zct gjL <br /> _ .S- �+ 'u /tit a.-/•vt1/'�f'rt kl�/�S' ou ~ <br /> 1�la-rd <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag [:ISJ Env H]th ❑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 /> Business Representative(Print Name and Title) Busines Representative(Si nature) <br /> / (�+ - aGt <br /> Name of Inspector and Fye Com ny <br /> RY COPY: FIRE PREVENTION REV 11/96 <br /> PIN COPY: BUSINESS <br /> OES-HMI (9M) <br />