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COUNTY. <br />SAN.JOAQUIN <br />;1M• .. <br />�4bMtf � co OFFICE OF'EMERGENCY SERVICES�� ��`" <br />r,• yROOM 610,COURTHOUSE <br />EAST:WEBERAVENUE` <br />- STO.CKTON, CAI:IEORNIA •.95202 <br />t Vii• <br />TELEPHONE` (209) 468-3969 <br />i • '• •• :• - .. •.. fir` __ .. .. ..... <br />•y.� It{r• {• _ . <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />'TELEPHONE NUM5. <br />BUSINESS NAbIE j a1J �O S: ►f <br />t : <br />DE <br />Inspected) f _ y <br />BUSINESS ADDRESS (Faci ty Bei dIJ / .. I. . ,�[/�� 0- > > <br />DEPARTURETIMEt 1NSPECI7 NW. <br />FIR`EDIS RICT : INSPECIIO� DA ARRiVALTIME , <br />�� IC:00 C' �YJ rpt Ci. i©rAb <br />7-n RESULTS � • 5�'� . N''„ <br />:..- <br />- INSPECTION ••; .. • � ••� T1O, <br />< " y NO = FACII:TTY WALK THROUGH <br />DOCUMENT REVIEW <br />` 1.:Busmess HMMP/Inventory On Site r Facility Map-Complete;and'Accurate.:.> <br />Chemical'Iiiventory Complete'& Accurate �� <br />2: HMMP/Map Easily Accessible to Employees _+ <br />Complete and Accurate 9. Employees Familiar with`HMMPi T�x'fiw' <br />3: Bus M Page/HM Compl 10. Plant Operations Appear Safe <br />4: If Business is a Hazardous Waste Generator; <br />11. Materials Properly Handled <br />6 ::are Hazardous Waste Manifests On Site , <br />H12.Materials Properly Stored and Labeled: <br />S:.Material Safety:Data Sheets (MSDS) On Site w ; <br />Records On Hand 13 Soil and Facility Appear Non -Contaminated -"'x z1�r. <br />6. Current. Training- rh <br />COMMENTS "(Items .marked ""NO„ . above must' be explained in this section) <br />F <br />„ y� <br />T , 'j i r a• <br />t � Ili. O•'`' Fn: .a i. :Eoy.,ilira�.�i:..:z'. <br />Yds` ..1 <br />-777777777 <br />' Z <br />C. <br />Fire Air Dist-77� <br />REFERRALS (FOR OES USE, ONLY) a SJ •Ag : ❑ SJ, Env Hlth a OSHA Y a , „• ,,yoxn 4 rtx,t, ; <br />IN PECTI N FOLI;O�V UP INFORMATION' Follow,t <br />• <br />' Corrective Actions Must Be Dclivered.To OES By Follow Up Inspection Date OES Inspector Name Performing;. <br />w -.- <br />------------------ <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS aturc <br />Business Representative (Print Name and Title), <br />Business Representative (S gn ) „ <br />ft/ <br />HrIE OES <br />COPY: <br />( J �, tty RE <br />Nam ector �}nd Fir Company, CANARY COPY 'FIRE PREVENTION <br />/ i .S- e _� P -BUSINESS'' <br />