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1 .. <br /> COUNTY OF SAN JOAQUIN <br /> o��ulN••s OFFICE OF EMERGENCY SERVICES <br /> a•�•.o <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> •' STOCKTON,CALIFORNIA 95202 <br /> t4�feoA`'�� TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS AME TELEPHONENUMBER <br /> BUSINESS ADDRESS(Facility Being Ins ( ted) 21P CODE <br /> C aR a e a C'r <br /> FIRE DISTRICT INsTwn9NDATE� ARRIVAL TIME DEPARTURE TIME INSPECTION <br /> INSPECTION ONTYPE <br /> TION RESULTS V <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 X <br /> 4.If Business is a Hazardous Waste Generator, 10.Plant Operations Appear Safe i <br /> are Hazardous Waste Manifests On Site 11.Materials Being Properly Handled <br /> 5.Material Safety Data Sheets(MSDS)On Site 1 112.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand J 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> Me U,jj h l fort Men �Ll COM71ger, <br /> Iri h� oe✓a. C�c L P �+-, <br /> Gh <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag []SJ Env Hlth ❑OSHA E] Fire E]Air Dist ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must B`e�Delivered To OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> 10 . � - 0/ <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Repres ve(Si e) <br /> C 401PI 1 p ` <br /> Name of Inspector and Fire Company WHITE PY: <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> OES HMI(t1W <br />