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COUNTY OF SAN JOAQUIN <br /> oRAuly, <br /> OFFICE OF EMERGENCY SERVICES <br /> m ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> �TYI'ac'A:+`�• TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> atilK SSTS /P 2Ic.6T 6 Y-!C 3.P <br /> BUSINESS ADDRESS(Facility Being Inspected) 21P CODE <br /> FIRE DISTRICT INSPECTION DA ARRIVAL TTME DEPARTURE TBvIE IN: MC HUN TYPE <br /> C 99 � 0 30 <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP/Inventory On Site x 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 X9. Employees Familiar with HMMP <br /> 4. If Business is a Hazardous Waste Generator, 10. Plant Operations Appear Safe X <br /> are Hazardous Waste Manifests On Site 11.Materials Being Properly Handled 7C <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 /> � <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 Delivereow Up Inspection Date OES Inspector Name Performing Follow Up <br /> d To OES By Foll <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Busine(/se's Re esentative(Signature) <br /> CA- M.- C.- <br /> OES <br /> Name of Inspector and Fire ompany CAN RYOCOPY: FIRE PREVENTION <br /> !//L/(1 Lk Lt ! PINK COPY: BUSINESS REV II/96 <br /> OES HMIQ1M9 <br />