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COUNTY OF SAN JOAQUIN <br />R•��41� c OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />r. 222 EAST WEBER AVENU9 <br />STOCKTON, CALIFORNIA 95202 <br />a�•- Ja��� TELEPHONE (209) 468-3969 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NA.titE� �1 <br />�c/[/ <br />-� <br />j/ , <br />^� <br />fi C � <br />ONE '-BER <br />% - ?51"6 <br />BUSINESS ADDRESS (Facilitv.13 'Tns c d) <br />21P CODE <br />FIRE Dl TRI 42947PECTION <br />ARRIVAL ME <br />DEP TURFLTIIviE <br />dS <br />S OTYPE <br />;<��iC,a <br />DOCUMENT REVIEW <br />RESULTS <br />YES NO FACILITY WALK THROUGH YES NO <br />1, Business HMMP/Inventory On Site <br />7. Facility Map Complete and Accurate <br />2. HMMP/Map Easily Accessible to Employees <br />S. Chemical Inventory Complete & Accurate <br />3. Bus ID PagP_AUv MP Complete and Accurate <br />9• Employees Familiar with HMMP <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site <br />10. Plant Operations Appear Safe <br />_1)-. Materials Being Properly Handled <br />5. Material Safety Data Sheets (MSDS) On Site <br />12. Materials Properly Stored and Labeled <br />6. Current Training Records On Hand <br />13. Soil and Facility Appear Non -Contaminated <br />CONLMENTS (Items marked "NO" above must be explained in this section) <br />���� ��rC t; /Y C � +'c� t- <'. '- �1� C r y' c-l<'i r Com• S <br />Ct <br />REFERRALS (FOR OES USE ONLY) C SJ Ag [] SJ Env Hlth [:] OSI':A []Fire [] Air Dist <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions Must Be Delivered To OES By <br />Follow Up Inspection Date <br />OES Inspector Name Performing Follow Up <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative (Print Name and Tit!c) <br />Business Representative (Signature) <br />Name of Inspector and Fire Company <br />4'. - .' % . _ <br />• <br />WHITE COPY: OEs <br />CANARY COPY: FIRE PREVENT ON <br />PINK COPY: BUSINESS <br />REV 11/96 <br />T 0 - d <br />p,nt <br />J tjMa a e2 = S T N`�'QW �T <br />