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' COUNTY OF SAN JOAQUIN <br /> O.t'4uIN'.0 OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> �: • 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> BUS. (209)468-3969 FAX(209)9449015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> �l07 h/Qr� �j f .�Y�n 95�07 <br /> FIRE DR71CT INSPECTION DATE ARRIVALTIME DEPARTURE TIME INS ON TYPE <br /> o�/��. , lov 0i 10- Oq to <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 i� 11.Materials Being Properly Handled <br /> 5. Material Safety Data Sheets (MSDS)On Site12.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 1 113. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> REFERRALS (FOR OES USE ONLY) []SJ Ag []SJ Env Hlth [—]OSHA Fire [:]Air Dist Ej <br /> INSPECTION FOLLOW UP INFORMATION <br /> Correc ive Actions st Be Delivered o OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> T <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> Ketd4p,' <br /> Name of�In/.spector and Fire Company WHITE COPY: OES <br /> CANARY�u.L G�lr9 Se��O'7�12+r/�� PINK COPY, BUS NESS PREVENTION REV 11/96 <br /> OES-HM 1 (9100) <br />