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it <br /> �4�Aa coc COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> P�iiFgd'�`�• TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME L , � TELEPHONE NUMBER <br /> BUSINESS ADDRESS (Facility Being Inspected) ZIPCfE <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE T11viE I INSPECTION TYPE <br /> 2v 2-2A e1`7 /3`tS 14 l5 <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 it3. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <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 Representative(Print Name and Title) B I ess prese iv (Si ature) <br /> 0 15LOAl C'a'm. <br /> Name of 14&pectora Fire Comp H COPY: OEs <br /> yy� A Y COPY: FIRE PREVENTION REV 11/96 <br /> 1 ' l�l INK COPY: BUSINESS <br /> OES HM I(III%) <br />