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cn Po�,N COUNTY OF SAN JOAQUIN ij II . <br />OFFICE OF EMERGENCY SERVICES PDD <br />r` ROOM 610, COURTHOUSE <br />e: •Z� <br />222 EAST WEBER AVENUE NOV f :'819W <br />STOCKTON, CALIFORNIA 95202 <br />°gt,Fo•Ra`P TELEPHONE (209) 468-3969 SAN JG IN COUNTY <br />HAZARDOUS MATERIALS PROGRAM INSPECTION ICE OF EMERGENCY SERVICES <br />BUSINESS NAME TELEPHONE NUMBER <br />5' l F RR4 C A L _q y a h <br />BUSINESS ADDRESS (Facility Being Inspected) ZIP C DE <br />Q L7S L ZD <br />FIRE DISTRICT <br />INSPECTION A <br />I 11 qI <br />ARRIVAL TIME <br />D D� <br />DEPARTURE TIME <br />INSP �"l I E <br />u <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES O <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 />3. Bus ID Page/FIMMP Complete and Accurate <br />9. Employees Familiar with HMMP <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site <br />10. Plant Operations Appear Safe <br />11. Materials Being Properly Handled <br />5. Material Safety Data Sheets (MSDS) On Site <br />12. Materials Properly Stored and Labeled <br />71 <br />i <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 />MAP <br />REFERRALS (FOR OES USE ONLY) SJ Ag SJ Env Hlth 0 OSHA Fire ❑ Air Dist <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Ac ions M st Be Delivered To OES By <br />11 2 <br />Follow Up Inspection Date <br />OES Inspector Name Performing Follow Up <br />ACKNOWL GEM T OF REVIEW AND RECEIPT OF INSPECTIQf4 IZESULTS <br />int Nate and itle) Bus epresentati ( ature) <br />Business RepresentatMND <br />r � <br />o <br />Name ofjQweetord ire C mpany A 1 <br />O II {1 <br />WHITt COPY: OES <br />CANARY COPY: FFIRE PREVENTION <br />PINK COPY: BUSINESS <br />�V 11/96 <br />OES • HM 1 (11/86) <br />