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COUNTY OF SAN JOAQUIN <br /> o°igUl� •c OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> ui66_0� <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> BUS. (209)468-3969 FAX(209) 944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS1N S NAME TELEPHONE NUMBER <br /> �v� <br /> BUSINESS ADDRESS(Facility Being inspected) ZIPCODE <br /> 7�a 7 a�f, y Gr ' 9Sv2O 7 <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> I. Business HMMP/Inventory On Site 7. Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees S. Chemical Inventory Complete&Accurate <br /> 3.Bus ID PagcfHMMP 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 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 /> 5 <br /> S <br /> REFERRALS (FOR OES USE ONLY) ❑Si Ag ❑SJ Env Hlth ❑OSHA ❑ Fire Air Dist j <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must Be Delivered To IDES By Follow Up Inspection Date OES Inspector Name.Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Bus' s Representative(Print Name and Title) Business Representative(Signature) <br /> ,3-1 /?') ACr e p SAT E3 f p S .DHAN�A <br /> Name 9f Inspector and FM' Company WHITE COPY: OEs i <br /> CANARY COPY: FIRE PREVENTION REV 11196 <br /> /v GL��LO PINK COPY: BUSINESS <br /> OES-HM 1 (WOO) <br />