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Qy„� COUNTY OF SAN JOAQUIN <br />a°tea �o OFFICE OF EMERGENCY SERVICES <br />�` ROOM 610, COURTHOUSE <br />'” ^222 EAST WEBER AVEN t <br />�' '' STOCKTON, CALIFORNIA 95202 <br />c`+' ;5—,kia*, TELEPHONE (209) 468-3969 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME ,P4. <br />— r -. <br />BUSINESS ADDRESS (Facility J3=g s c d) <br />`, <br />fi '' r1 T E' <br />' / ONE ER <br />7 � -- 2S!� <br />CODE <br />Du <br />ec <br />INS O D <br />ARRIVAL TIME <br />DFP TURF_TT NE <br />S Of; �r�,, <br />DOCUMENT REVIEW <br />ECTION RESULTS <br />YES NO FACILITY WALK THROUGH YES NO <br />1, Business HMMP/Inventory On Site <br />7. Facility Map Complete and Accurate <br />2. HMMP/Map Easily Accessible to Employees <br />8. Chemical Inventory Complete & Accurate <br />3. Bus ID PagcA1MMP Complete and Accurate <br />9. Employees Familiar with HMMP <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site <br />10. Plant Operations Appear Safe <br />j)-. Materials Being Properly Handled <br />5. Material Safety Data Sheets (MSDS) On Site <br />12. Materials Properly Stored and Labeled <br />6. Current Training Records On Hand <br />13. Soil and Facility Appear Non -Contaminated <br />COM,'MENTS (Items marked "NO" above must be explained in this section) <br />C) 011 le <br />REFERRALS (FOR OES USE ONLY) 11 SJ Ag SJ Env Hlth OSHA Fire Air Dist <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions Must Be Delivered To OES By <br />Follow Up Inspection Date <br />OES Inspector Name Performing Follow lip <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative (Print Name and Title) <br />Business Representative (Signature) <br />Name of Inspecjor and Fire Company <br />i . <br />', I; 1. �. .r % . _ =• _: _, •... ..... <br />WHITE COPY: OEs <br />CANARY COPY: FIRE PREVENTION <br />PINK COPY: BUSINESS <br />, 11/96 <br />L 0 " d <br />leiJ dMQdS 8g = S r h7V1W T I I <br />