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RUIN <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> s <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TqEP HONE NUMBER <br /> `ftz- 3 b <br /> BUST ESS DRESS(Facility Being Ins ected) ZIP CODE <br /> a `?S_ <br /> FIRED TRICT f INSPECTION DATE AKMVAL HNIEDEPARTURE TIME I INSP ON / <br /> IC 6 TO. <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 I 1 113. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> d 2 <br /> to rn <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 R L <br /> Busines resentative(Print Name and Title) Business pr tati (Signature) <br /> Name of Inspector and Fire C!Zany WHITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> —Q. L PINK COPY: BUSINESS <br /> O S-NM1(1aft) <br />