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COUNTY OF SAN JOAQUIN''-- <br /> oP4�0 OFFICE OF EMERGENCY SERVICES <br /> r.' ROOM 610, COURTHOUSE <br /> w: 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> BUS. (209)468-3969 FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUNAME TELEPHONE NUMBER <br /> BUS <br /> 15_�v est # ZDV 3�,)- 05,.2 - <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIPCODE <br /> 1Vo2 7 b i' VI'n C-e Or 7 <br /> FIRE P15TRICT INSPECTION DATE ARRIVAL TIME DEPARTURETIME INSPECTIONTYPE <br /> 9 0714S <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 N — <br /> are Hazardous Waste Manifests On Site 11.Materials Being Properly Handled <br /> 5. Material Safety Data Sheets (MSDS) On Site12.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 1 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must#b, ,, ned in this section) <br /> 4- <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag ❑SJ Env Hlth EIOSHA D Fire E]Air Dist ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must Be Delivered To OES By Follow Up Inspection Date OES Inspector Name Performing Fallow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> 6)A, /114-S//Y6 h- - <br /> Name o .Inspector and Fire Company WHITE COPY: OES <br /> D � > CANARY COPY: FIRE PREVENTIONREV11196 <br /> PINK COPY: BUSINESS <br /> OES-HM 1 (9700) v <br />