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PQ�,N COUNTY OF SAN JOAQUIN <br />�o..coG OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />a: 222 EAST WEBER AVENUE <br />STOCKTON, CALIFORNIA 95202 <br />TELEPHONE (209) 468-3969 <br />,�►FON <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME <br />S' e oL kj2_.,c_`4 <br />TELEPHONE NUMBER <br />9FS— ,7P <br />BUSINESS ADDRESS (Facility Being Inspected) <br />ZIP CODE <br />FIRE DISTRICT <br />C <br />INSPECTION DATE <br />1-2-h J29 <br />ARRIVAL TIME <br />13` <br />DEPARYURE TIME <br />/ S <br />INSP CTION TYPE <br />Oi4ligc <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP/Inventory On Site <br />7. Facility Map Complete and Accurate <br />2. HMMP/Map Easily Accessible to Employees <br />8. Chemical Inventory Complete & Accurate <br />9. Employees Familiar with HMMP <br />3. Bus ID Page/HMMP Complete and Accurate <br />10. Plant Operations Appear Safe <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site <br />/ <br />N <br />11. Materials Being Properly Handled <br />5. Material Safety Data Sheets (MSDS) On Site <br />12. Materials Properly Stored and Labeled <br />6. Current Training Records On Hand <br />13. Soil and Facility Appear Non-Contaminated <br />COMMENTS (It�e)ms marked "NO" above must be explained in this section) <br />>rT <br />i r ✓a ..1 ...a I's no C c4lle-1L <br />-2 AA,­- U,_,J' 1 a LA-1 <br /># 10 — ,< e-- cool J rov <br />aXq 8, <br />REFERRALS (FOR OES USE ONLY) EISJ Ag [] SJ Env Hlth OSHA Fire [] Air Dist <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions Must Be Delivered To OES By <br />lZ 1p -19 <br />Follow Up Inspection Date <br />1 <br />OES Inspector Name Performing Follow Up <br />ACKNOWLEIYGEMLfNT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative (Print Name and Title) <br />Business pre ative (S' n re) <br />Name of Inspect,d Fire Company <br />L <br />j Z <br />WHITE COPY: OES <br />CANARY COPY: FIRE PREVENTION <br />PINK COPY: BUSINESS <br />I REV 11/96 <br />OES - HM 1 (11196) <br />