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la,,y COUNTY OF SAN JOAQUIN <br /> a4':�Q£oma OFFICE OF EMERGENCY SERVICES <br /> a ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADD SS,(Facility Being Ins cted) //11 ZIPCODE <br /> .2 V-0 7 G✓. InaA cr LaNL' �SAOCIPZ44 96-2-07 <br /> _ D TRICT INS ND ARRIVALTIMEDEPARTURETTME SPECTIO TYPE <br /> CQ�i0 <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/HM[MP 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 12.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 /> Co 2 <br /> lc 99y <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag E]SJ Env Hlth ❑OSHA Ej 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 o Insp for and itComp y cn TE COPY: FIREOES PREVENTION <br /> 2Z PINKCOPY: BUSINESS REV 11/96 <br /> OES HM Oli" <br />