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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> rROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> ���%FSAN��• TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TFl FPHONE NUMBER <br /> 4 'C'� <br /> BUSINESS ADDRE S(Facility Being Inspected) ZIP CODE <br /> FB2EDISTRICT INS ON DATE ARRIVAL TIME DEPARTURETA9E INSPECTION E <br /> Io RA /D v <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 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 113.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> v Cu s <br /> C <br /> REFERRALS (FOR OES USE ONLY) SJ Ag ❑SJ Env Hlth []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 /> Bust ss RRese*GU�t Name and Title) Busin eprese tiv i e) <br /> Cr N e o nsp rand Fir mp WH PY: OI?S <br /> CANARY COPY: FBtE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> OES-HMI(I IM) <br />