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AL <br /> A� N. COUNTY OF SAN JOAQUIN "1,11 <br /> r <br /> �o. .0 OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE t L <br /> 222 EAST WEBER AVENUE r <br /> ` STOCKTON,CALIFORNIA 95202 M 3.01999 <br /> cti F O R+`P TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTIO FORM <br /> BUSINESSINAME TELEPHONE <br /> BUSINESS ADDRESS(Facility Being Inspected) I Y <br /> / y CODE <br /> � C_&r(0. J '1 {, D <br /> FIREDISTRI INSPECTION ATE ARRUVAL,IUVW DEPARTURE TIME INSP ON TYPE <br /> JC � tJ <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/IIMMP 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 IMIAT <br /> 6.Current Training Records On Hand 113.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> O G.&R. 0C vli .5 <br /> f , <br /> C. P C,fA S <br /> YN -�r I % CA 5 ` <br /> 1 h-i ` V' r1-}� Ir,r a'�' O✓\ c% + i�IM <br /> y <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag ❑SJ Env Hlth Ej OSHA Fire ❑Air Dist <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must Be Delivered To O By Follow Up Inspection Date ES Inspector Name Performing Follow Up <br /> I 4WACKNOWLEDGEMENT OF REVIEW AN RECEIPT OF INSPE TION RESULTS <br /> Business Representative(Print <br /> Name and Title) <br /> Busine Representative Signat e) <br /> e4 Lgca'!5i'C aVf1X,� <br /> ame nspector and Fire C mpany WHITE COPY: OES <br /> a r �� 1 CANARY COPY: FIRE PREVENTION REV 11/96 <br /> W Sr ( I 1 PINK COPY: BUSINESS <br /> PNr K' 0E -HM1111/W <br />