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COUNTY OF SAN JOAQUIN <br /> R....N. <br /> >q•�a•�o OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> �''• iP TELEPHONE(209)468-3969 <br /> q[ico'�N <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAMETELEPHONENUMBER <br /> U /t t <br /> BUSINESS ADD SS(Facility Being Inspectell) ZIP CODE <br /> �-y „d 'i 1'r4 e -v'- <br /> FI ISTRI CT INSPECTION DATE DEPARTURE INSPECTION TYPE <br /> a l i-7 tel f 1c if M ASO <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 1 12.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 1 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> a 44 <br /> VVG Lf K4n�� u <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag ❑SJ Env Hlth OSHA Fire E]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 /> Busi�Reprersentative(Print Name and Title) Business Re se a(Signature) <br /> 1JA JD 4 w nn! V0Li DIV-S 0;2. �1-- <br /> Name of Inspector and Fire Company WHITE COPY: GES <br /> Pd r CANARY COPY: FIRE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> OES-HMt(t IM) <br />