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COUNTY OF SAN JOAQUIN <br /> 0p4u'N• C <br /> OFFICE OF EMERGENCY SERVICES <br /> RECEIVED <br /> a < ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE BE C 15 2000 <br /> STOCKTON, CALIFORNIA 95202 <br /> SAN�a�koaa`P NTY <br /> TELEPHONE(209)468-3969 OFFICEOF EME GENCYS RE ICES <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> f( O_To ZO►-C� ill �? 3:9-- ',.q - `-14vw <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIPCODE <br /> FIRE DISTRICT INSPECIIONDATE ARRIVALTIME DEPARTURE THVIE I INSPECTION TYPE <br /> MA� z 2• b - do "bo (I" 2U "Vins <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 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 112.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> S � <br /> REFERRALS (FOR OES USE ONLY) DSJ Ag E]SJ Env Hlth OSHA [:] Fire E]Air Dist <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Mus[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 InSpeC an lr pant' WHITE COPY: OES <br /> �^ Z CANARY COPY: FIRE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> OS HM1(11W <br />