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• 0 <br /> COUNTY OF SAN JOAQUIN) <br /> >° £p OFFICE OF EMERGENCY SERVICES <br /> ` a ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> =- STOCKTON,CALIFORNIA 95202 <br /> o't/FodN`' TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME _ TELEPHONE NUMBER <br /> Cil <br /> BUSINESS ADDRESS(Facility Being Ins cted) ZIP CODE <br /> 37a s . 14 19 95-Z/,_5- <br /> FIRE <br /> y yDyISTRICT INSP OND ARRIVAL TAME DEPARTURE TATE INSP ON TYPE <br /> /„orr4e� U," h J� /- z000 /3/,S, ; V-& /�lJ9IY/S� <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 L11 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> r / <br /> lO — a �aL�o crime / {�ain , vt //' e✓of (Jcn�✓ e_ <br /> ✓2ct evi- J �Ge .i G,�e.✓ o.. <br /> Xas <br /> / Q.✓-L ✓� �.-.�� <br /> K r K- r e <br /> by <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag ❑SJ Env Hlth ❑OSHA Ej 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 /> ACKNOW D EAT OF R IEW AND RECEIPT OF INSPECTION RESULTS <br /> B ess Repsofitafive me Title) Business Representative(Signature) <br /> ame of Inspector and Fire CompanyWHITE COPY:OES <br /> 904 <br /> �/ _ -� Z, CANARY COPY: FIRE PREVENTION REV 11/96 <br /> /�� 'Pir C'� PINK COPY: BUSAIESS <br />