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! 0 <br /> COUNTY OF SAN JOAQUIN <br /> ag4U1N"s OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> a <br /> 222 EAST WEBER AVENUE <br /> •' STOCKTON,CALIFORNIA 95202 <br /> p TELEPHONE(209)468-3969 <br /> F i ORii <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility Being I�cted) ZIP CODE <br /> ,2S 93 <br /> FIREDISTRICTINSPECT[ DA ARRIVAL TIME DEPART[JRETBvIE I INSPECTIOsN TYPE <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 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 /> So o Z <br /> Z• SC O 6 Cin AL -Od 74-COl <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag [:]SJ Env Hlth ❑OSHA E] Fire ❑Air Dist D <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must Be Delivered To UES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> BuLof <br /> iness Representative(Print Name and Ti le) Business Representativ ignature) <br /> � OES <br /> c or an ire any CRNAWHITCOP ' FIRCANARY COPY: FIRE PREVENTION RBV 11/96 <br /> ` PINK COPY: BUSINESS <br /> OES HM 1(11W <br />