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Q COUNTY OF SAN JOAQUIN <br /> !1,!N <br /> s°� o OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS (FacilityBeing Inspected) ZIPCODE <br /> 9SL <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME I INSPECTION TYPE <br /> �1ict� (v <br /> 73 9' l-;3Z„ fix' wv/-� <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, ,f 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site /Y 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 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> f9t& A/U 'Cly S cIY S> <br /> REFERRALS (FOR OES USE ONLY) 11SJ 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 /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usiness Re entative(Printf Name`and Title) Busines Representative(Si nature) <br /> 608--S41-1 le7 <br /> �I A1.1J�riCJ <br /> am o �ry WHITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11196 <br /> PINK COPY: BUSINESS <br /> OES-HM 1 01)96) <br />