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IS <br /> Pa�,N COUNTY OF SAN JOAQUIN <br /> s° poa OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> c1<1Fc BUS. (209)468-3969 FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINES/SNAME / <br /> TELEPHONE NUMBER <br /> cva,,�el <br /> BUSINESS ADDRESS(Facility Being Inspected) .22e/—,27190� ZIP CODE <br /> 9,5'0 1h�'csfn� ✓J2 9s-a-o6 <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTU?TIME INSPECT ION TYPE <br /> sf� 7- s-Oa 9: 0t � : S $ P40A <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> I. Business HMMP/Inventory On Site kl . 7. Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees k/ 8. Chemical Inventory Complete&Accurate <br /> I:E: <br /> 3.Bus ID Page/HMMP Complete and Accurate 1/ 9. Employees Familiar with HMMP <br /> 4.If Business is a Hazardous Waste Generator10.Plant Operations Appear Safe `s <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 1 113.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) Cyt <br /> r— -- <br /> -,466 d ee� <br /> _ Costa of e �e �r�r <br /> - �- � <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 /> 9- 6- oa <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business r sentativ igna r <br /> A/6(f ke G <br /> Name of Inspector and Fire Company -WHITE CO : OES <br /> �J/_ ,L �r (� i/9� !�✓� CANARYCO IREPREVENTION REV II/96 <br /> 'VGVI J O'4 PINK C)PY: BUSWESS <br /> OES-HM1 (9100) <br />