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0 . <br /> PR 1N COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE O <br /> -' STOCKTON,CALIFORNIA 95202 <br /> . a•�H`'.� TELEPHONE(209)468-3969 t.. FSO <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FOR FGEpCYs ry <br /> BUSINESS NAME TELEPHO <br /> S L r510) ;t 7- IS <br /> SS <br /> BUSINEADDRESS (Facility Being Inspected) ZIP CODE <br /> ti = l�-mnne2 W T'C)CKrvni A-, 210 52 O <br /> FIRE DISTRICT INSPECTION DATE AKMVALTIME DEPARTURETIME. INSPECTIONTYPE <br /> 99 1 /-FMMP <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1. Business HMMP/Inventory On Site )( 1 7. Facility Map Complete and Accurate J( <br /> 2.HMMP/Map Easily Accessible to Employees T 8. Chemical Inventory Complete&Accurate <br /> 3.Bus ID Page/HMMP Complete and Accurate u 9. Employees Familiar with HMMP <br /> 4.If Business is a Hazardous Waste Generator, 10.Plant Operations Appear Safe X <br /> are Hazardous Waste Manifests On Site NIA- 11.Materials Being Properly Handled <br /> 5.Material Safety Data Sheets(MSDS)On Site X12.Materials Properly Stored and Labeled x <br /> 6.Current Training Records On Hand X 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 /> Business Representative(Print Name and Title) Business ep sen tive(Signature) <br /> Name of Iggpector and44Fi o y WHITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> PINK COPY: BUSRVESS <br /> OES-HM 1(111%) <br />