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Pa�,H COUNTY OF SAN JOAQUIN <br /> so. "" ••.o OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> C4trFOR��P BUS. (209)468-3969 FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> HUSISNAME& �,, TELEPHONE NUMBER <br /> %66ps <br /> BUSINESS ADDRESS(Facility Being Inspected) en ZIP CODE <br /> Z41 aelz� IV <br /> LIREDI ICT WSPECTIONDATE ARRIVAL TIME DEPARTURE TIME WSPECTION TYPE <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> I. 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 N/ 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 113. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> REFERRALS (FOR DES 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) Busin ss Represe 1 (Signature) <br /> 1 _ <br /> Name ot Jnspector and Fire Company WHITE COPY: OES <br /> �� 2 PINK CANARY <br /> COPY: FIRE BUSINESS PREVENTION REV 11/96 <br /> OES-HM1 (9100) <br />