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COUNTY OF SAN JOAQUIN <br />oP°�IN c OFFICE OF EMERGENCY SERVICES <br />r. y 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 <br />TELEPHONE NUMBER <br />BUSINESS ADDRESS (Facility Being Inspected) <br />ZIPgCODE <br />FIRE DISTRICT <br />INSPECTI N DAY <br />ARRIVAL TIME <br />DEPARTURE TIME <br />INSPECTION TYPE <br />8 Z 7�OZINSPECTION RESULTS <br />DOCUMENT REVIEW YES NO 1d.• OS FACILITY WALK THROUGH YES NO <br />1. Business HMMP/Inventory On Site <br />X <br />7. Facility Map Complete and Accurate <br />2. HMMP/Map Easily Accessible to Employees <br />X <br />8. Chemical Inventory Complete & Accurate <br />Employees Familiar with HMMP <br />3. Bus ID Page/HMMP Complete and Accurate9. <br />10. Plant Operations Appear Safe <br />4. If Business is a Hazardous Waste Generator, <br />oor <br />111. Materials Being Properly Handled <br />are Hazardous Waste Manifests On Site <br />Y <br />5. Material Safety Data Sheets (MSDS) On Site <br />X <br />12. Materials Properly Stored and Labeled <br />6. Current Training Records On Hand <br />13. Soil and Facility Appear Non-Contaminated <br />COMMENTS (Items marked "NO" above must be explained in this section) <br />WOL' fr s �l e -9-- <br />e pl <br />_ <br />S-�Ce11" 0,11S <br />Q <br />4/w r CL7 �% il.� r e- eoco� 3.( .�✓ <br />�. <br />7 aleor <br />�f �i��s � .�%Y�11•tl��i����� �G)`cG /�7E�L�.��_L7�P�� <br />G Gr4exZ'ii • % /-%-� CGS /�i� �y, Cr�Cfi� �tL <br />REFERRALS (FOR OES USE ONLY) SJ Ag SJ Env Hlth [:]OSHA Fire Air Diet <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Ac ions Must Be Delivered To OES By <br />Follow Up Inspection Date <br />OES Inspector Name Performing Follow Up <br />ACKNOWLEDGEMENT OF REVIEW .AND RECEIPT OF INSPECTION RESULTS-, <br />Business Representative (Print Name and Title) <br />Busi s5 Re ntat ig ature) <br />'Rt'c)4rd e— boss � it 1 <br />Name of Inspector and Fire ComM11 <br />WHITE COPY: OES <br />CANARY COPY: FIRE PREVENTION <br />REV I I/96 <br />/ f ` <br />PINK COPY: BUSINESS <br />utJ - M. I kyi l <br />