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COUNTY OF SAN JOAQUIN Mv <br /> oR4�IN' .c OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> ��•• i;:P BUS. (209)468-3969 FAX(209)944-9015 <br /> �1FOP <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS N.�E TELEPHONE NUMBER <br /> 9L /oer o 957-dZ91 <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> as-93 a! Z07 4Sa-07 <br /> PIREDI ICT INSPECTION DATE ARRIVAL TIME DEPARTURE TQv1E I INSPE�I7ONTYPE <br /> Ori — .3 f- 0 c9— ' S % 2O /�C66La-ep <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> I. Business HMMP/Inventory On Site 7. Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees 8. Chemical Inventory Complete&Accurate t� <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 N 11.Materials Being Properly Handled L� <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 /> No 4 ra i t, r ep�roL g o N &a_., 'e .4- ac <br /> owjav q %- /a- v <br /> 4� 1 — 9;4 "Z-0.0. axe <br /> Ye . <br /> REFERRALS (FOR OES USE ONLY) E:]SJ Ag [-]SJ Env Hlth 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 /> 9-/O - Q.,)- I I <br /> ACKNOWLEDGEMENT <br /> -io - Q.,)- <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> �v�Lai�9?BGL- <br /> Namee ff Inspector and(Fge Company WHITE COPY: FIRE PREVENTION <br /> �7 CANAV�6 f/fl��-� PINK COPY: BUSINESS REV 11/96 <br /> OES-HM 1 (9/00) <br />