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COUNTY OF SAN JOAQUIN <br /> O.�''4ulN c OFFICE OF EMERGENCY SERVICES <br /> r.` s ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> • �'•. <br /> 1FO . :P BUS. (209)468-3969 FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> ,4t— /-7/0M51;-,S -?4g— <br /> BUSINESS <br /> 48BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> r/ SSSAleY 9 <br /> FIRE DISTRICT INSPECI ION DA It ARRIVALTIME DEPARTURETIME INSPECTIONTYPE <br /> r8/eii /-��3 -�� /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 <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 v <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 L <br /> 5. Material Safety Data Sheets (MSDS) On Site 12.Materials Properly Stored and Labeled y <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 /> a <br /> ��o <br /> (( Yn c)-,w Oen !ri , 152T 77Th F <br /> REFERRALS (FOR OES USE ONLY) 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 /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business presentative ignatur ) <br /> L'A NA <br /> ^N <br /> Name of Inspector and Fire Company wH TE Y: oEs <br /> ajL1/GL1� ��LL PINK COPY: BUSINESS CANARYCOPY ENTION REV 11/96 <br /> OES-HM1 (9/00) <br />