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IdIkk <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> s Z., ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> C'�(jF�•�1��' TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME // TELEPHONE NUMBER <br /> dC4i <br /> BUSINESS ADDRESS (Facility Be' Inspected) ZIPCODE <br /> FIRE DI TR1CT. INSPECITO DATE RR <br /> AIVAL TIME DEPARTURE TIME INSPECTION E <br /> If 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 <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 /> fn I (Z L <br /> Q l <br /> _� <br /> 1 4 n <br /> r,e—Mc t,' <br /> REFERRALS (FOR OES USE ONLY) SJ Ag [:]SJ Env Hlth OSHA Fire Air Dist <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective +Actions M st Be elivered To OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> AC OWLEDGEMENT OF REVIEW , IND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Fepresentative •gnature) <br /> LaVnrector d Fir Company WTUTE COPY: OE <br /> CANARY COPY: FUTE PREVENTION REV 11/96 <br /> --2— PINK COPY: BUSINESS <br /> OES-HM 1(11198) <br />