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COUNTY OF SAN JOAQUIN <br />�4•�A� OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />e X222 EAST WEBER AVENU9 <br />•'• STOCKTON, CALIFORNIA 95202 <br />�`i •ye.�;:t� TELEPHONE (209) 468-3969 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NA%1E/' �. <br />�,_ - (_ -/-I <br />NE ER <br />BUSINESS ADDRESS (Facilit�$eing"TnsPFC ed) <br />21P CODE <br />/ <br />FIRE ro <br />INS O DATE l <br />A uR,W TUAE <br />DEP TURF,4TME <br />,S79 / <br />ECTION RESULTS <br />DOCUMENT REVIEW YES NO FACa= WALK THROUGH YES NO <br />I. Business HMMP/Invcntory On Site <br />7. Facility Map Complete and Accurate <br />2. HMMP/Map Easily Accessible to Employees <br />8. Chemical Inventory Complete & Accurate <br />3. Bus ID PageAU MP Complete and Accurate <br />9. Employees Familiar with HMMP <br />10. Plant Operations Appear Safe <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site <br />_1)- Materials Being Properly Handled <br />5. Material Safety Data Sheets (MS DS) 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 />CONLMENT'S (``Items marked "NO" above must be explained <br />/�in this section) <br />7 IJ, r t ; �• i <br />rfitr, <br />REFERRALS (FOR OES USE ONLY) 13SJ Ag D SJ Env Hlth []OSHA O Fire [] Air Dist <br />INSPECTION FOLLOW LP 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 />Business Representative (Print Name and Title) <br />Business Representative (Signature) <br />Name of Ins or. an I Fire Company <br />/ ` .. �, <br />G • - 4. .� % ._ .: _.... <br />WHITE COPY OES <br />CANARY COPY: FIRE PREVENi10N <br />PINK COPY: BUSINESS <br />�y 11/96 <br />T11.1. <br />TO d <br />J�dma"a: 8£ L S'r fJ W T �i <br />