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COUNTY OF SAN JOAQUIN <br /> opo Lilly...c OFFICE OF EMERGENCY SERVICES <br /> r.` y ROOM 610,COURTHOUSE <br /> ni < 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> °�ilFOR:+P BUS. (209)468-3969 FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> 7 E1 2l40 9'39-- o679 <br /> BUSINESS ADDRESS(Facility Being Ins ected) ZIP CODE <br /> q-9 4Zs, <br /> FIREDIS ICT INSPECT D ARRIVALTIMF. DEPART URE TIME INSPECTION TYPE <br /> o z //-S-d d?l <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YIES 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, I 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 v <br /> 6.Current Training Records On Hand J�j 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must/ be explained in this section)) / <br /> o ; OI <br /> r -e AveL f.04 /2 C_0.,dr- <br /> a <br /> ._ i 1 k., « es,i M <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag ❑SJ Env Hlth OSHA ❑ Fire ❑Air Dist <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must Be Delivered To DES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> JJ V 22 Zcso Z <br /> ACKNOWLE EMENT OF REVIEW AND RECEIPT OF INSPECTIOtt RESULTS <br /> Bu iness Representative(Print Name and Title) Bu <br /> sin s Repres Signature) <br /> 2rew lyres <br /> Name of Inspector and Fire Company WHITE COPY: OHS <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> -+? PINK COPY: BUSINESS <br /> OES-HM 1 (9/00) <br /> 1� <br />