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COUNTY OF SAN JOAQUIN <br /> �o. .coG OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> s: <br /> < 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS= <br /> TELEPHONENUMBER <br /> � <br /> BUSINESS ADDESS( acihy Bem inspected) � ZIDE <br /> 2Z 3 /J ^ <br /> 70 /n= s © C_k foo 91 <br /> FIRE DISTRICT INS ND TE ARRIVALTIME DEPARTURETIME I INSPECTION <br /> � /2 /7/9 P 20 3 d C L /avl <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 112.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 /> X00 /6s 2 <br /> 7-�4s <br /> REFERRALS (FOR OES USE ONLY) SJ Ag []SJ Env Hlth EjOSHA 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 /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Busi ss Re tatixe Sl a ) <br /> Jct <br /> Name Spector and ire mpany WHITE COP -. OPS <br /> e)XCANARY COPY: FIRE PREVENTION REV]]/96 <br /> 0 Z PINK COPY: BUSINESS <br /> OSS-MM 1(111W <br />