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COUNTY OF SAN JOAQUIN <br /> o�4�1N .c OFFICE OF EMERGENCY SERVICES <br /> e: a •.o <br /> ROOM 610,COURTHOUSE <br /> a: . < 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> • c-.. ;r• BUS. (209)468-3969 FAX(209)944-9015 <br /> *GI F6-RN <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE MJMBER <br /> 1a,t ;,1,7 "-V- &X #t <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> ,?5-A4 La 'e- f7�nnn tory 9Sozo 7 <br /> FIRE DIST}ICT INSPECTION DATE ARRIVALTIME DEPARTURE TIME INSPECTION TYPE <br /> S' t'�*I NIS o1 9 : IS `3 <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 ]r/ <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 /" � A- 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 /> - <br /> 1 14 `�1 <br /> 9- - 19 <br /> REFERRALS (FOR OES USE ONLY) SJ Ag SJ Env Hlth [JOSHA 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 /> [N'ame'oCANARY <br /> siness presentative(Print Name and 'tle) tA" Bus' ss presentativeRe (Signature) <br /> uto <br /> COPY: FIRE PREVENTION REV II Inspector and Firms o an WHITE COPY: OESN6 <br /> PINKCOPY: BUSINESS <br /> OES-HM t (9/00) <br />