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• 0 <br /> COUNTY OF SAN JOAQUIN <br /> >9• a•�o� OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> ai X 222 EAST WEBER AVENUE <br /> ''•. STOCKTON,CALIFORNIA 95202 <br /> �''• r TELEPHONE(209)468-3969 <br /> 4�I F Chi <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> r S93 _ p <br /> BUSINESS ADDRESS(Facility Bein I s ected) I ZIP CODE <br /> FIRE DISTRICT INS D ARRIVAL 11Mh j InIrpKLURETAME I INSPECTION TYPE <br /> W1 4 7 2 � OO /0.,00 1 <br /> INSPECTION RESULTS <br /> DOCUMENTREVIEW 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 112,Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 113. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO"" above must-/-A <br /> Lbe explained in this section) / <br /> n OI/ � - /�I Ol U -e CO,/C,I' L4 <br /> a. <br /> P Cy <br /> at4 <br /> REFERRALS (FOR DES USE ONLY) ❑SJ Ag ❑Si Env Hlth OSHA Fire Lj 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 /> 2.00 0 <br /> AC OW DGEMENT REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Bus' s Representative(Print Name and Title) I B 'nes presentative(Signature) <br /> Name of Inspector and Fire Com ywtlrrE COPY: <br /> CANARY COPY: FXPREVENT10N REV 11/96 <br /> ��; PINK COPY: BUSINESS <br />