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COUNTY OF SAN JOAQUIN <br /> aoRA .co OFFICE OF EMERGENCY SERVICES <br /> r.% s ROOM 610, COURTHOUSE <br /> ` 222 EAST WEBER AV ENUE <br /> w :t <br /> _ STOCKTON, CALIFORNIA 95202 <br /> • ���/Pb, i;:r• TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BER <br /> BUSINESS NAME TELEPHONE NUM <br /> ) 1((0-6/00 <br /> V W 6 J 0. <br /> BUSINESS ADDRESS (Facility Being inspected) ZtP CODE <br /> I I S. A o- S k H CJ s-za <br /> FIRE DISTRICT I"i E ON DATE ARRIVAL nmE DEPARTURE TIME INSP ON TYPEE <br /> Sr6ckfv S /i <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1. Business HMMP/Inventory On Site7. Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees S. 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, ]0.Plan[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 <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 /> ')Uz&, ss 9a//n c L✓t✓>(C of <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag SJ Env Hlth E]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 /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Businewa resentative(Print Name and Title) Busine s Representative(Signature) <br /> 7 �' 1pcy <br /> Na of . ector and Fire Company COPY: Es�e GZ CIA ARY NK COPYOPY: FIRE NESS PREVENTION REV 11/96 <br /> OES-HM1)t V%) <br />