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R COUNTY OF SAN JOAQUIN <br /> Ul/y <br /> �o .coG 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 Being Inspected) r ZIPCODE <br /> l-��mrw_e,- L cz�n J e- /C%c 9.-5-2/Q <br /> FIRE STRI 1NSPECTT N DrATE ARRIVAL TIME DEPARTURE TIME INSP�crION�YPE <br /> IS_ <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP/Inventory On Site 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 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 11.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 /> 1 1. C _0 z <br /> «rt 4_1 C0 LLj <br /> '7 <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 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 epresentative(Print Name and Title) �iness Repres tative(Si Lure <br /> Name spector d F're pany - ITE CO OES <br /> C NARY COPY: FIRE PREVENTION REV 11/96 <br /> Lo PINK COPY: BUSINESS <br /> OES-HM 1(11/96) <br />