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COUNTY OF SAN UIN JOA <br /> ��►N Q <br /> OFFICE OF EMERGENCY SERVICES <br /> ?, ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility eingThs c ed) ZIP CODE <br /> FIRE DI TRIC` IN SPE O DATE ARRIVAL TWE DEPARTURE TIME INS ECTIO TYPE / <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP/Inventory On Site I 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 1 .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 /> Ain 0-01 <br /> emd <br /> vac <br /> IS <br /> a ` <br /> 21 <br /> REFERRALS (FOR OES USE ONLY) 1:1 SJ Ag SJ Env Hlth OSHA Fire [:]Air Dist <br /> INSPECTION FOLLOW UP 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 anj Title) Business Represen e( "na ur <br /> n � <br /> Nameof Ins ec aryd ire o py ITE COPY: OES <br /> b CANARY COPY: FIRE PREVENTION REV 11/96 <br /> C� fP .� PINK COPY: BUSINESS <br /> OES-HM 1(11/96) <br />