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.1 .• � 8(05 <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a ROOM 610,COURTHOUSE <br /> c a <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> TELEPHONE(209)468-3969 <br /> '�tiYo A? <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> 0 <br /> Id '5� -OSO? <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 2 e, Lance 9s2_09 <br /> FIRE DIS Cr INS ON Wh ARRIVALTIME DEPARTURE TIME INSON TYPE <br /> l/ .:`b 9 OQ �s i cc <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 113.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> O <br /> e 12 <br /> REFERRALS (FOR OES USE ONLY) SJ Ag Lj SJ Env Filth Lj OSHA U 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 Repres tative(Print Name and Title) Busin Representa ' e(Signature) <br /> C� r <br /> Name of In for/and F1'LCompany JIre COPY: OBS <br /> c5 c✓7 i CANARY COPY: FIRE PREVENTION <br /> Z PINK COPY: BUSINESS REV 11/96 <br /> OES-HM 1(ll/p8) <br />