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COUNTY OF SAN JOAQUIN REC�vE <br /> aa�ln. C'(jC' <br /> OFFICE OF EMERGENCY SERVICES <br /> v' a ROOM 610, COURTHOUSE <br /> a ' " 222 EAST WEBER AVENUE NOV 15 20 <br /> STOCKTON,CALIFORNIA 95202 S1W <br /> i bii'a'�`' TELEPHONE(209)468-3969 + OF=9 SENIVRW Ec <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Summit American, Inc. DBA: Summit Roofing 825-3042 <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 705 Industrial Park Drive 95337 <br /> FIRE DISTRICT INSPECIIONDATE ARRIVALTIME DEPARTURE TIME INSPECTION TYPE <br /> 24 l0\23 ou t7Got CFi'3a tit_ <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.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 X 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 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 /> I/ <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag SJ Env Hith []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 Representative(Signature) <br /> Name of Inspector And fire Company WHITE COPY: OES <br /> --r-r--- CANARY COPY: FIRE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> OES-HM 1(11/%) <br />