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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES 4D 15 <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> "• _ STOCKTON,CALIFORNIA 95202 <br /> 'CiFGpN <br /> • TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSgqESS NAME TELEPHONE NUMBER <br /> Cvdl,4 EnrrtR Risme &W ;33y1-Z#(l/ <br /> BUSINESS ADDRESS(Facility,Being Inspected) ZIP CODE <br /> Z 3 sx. $2 <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIMEINSPECTION TYPE <br /> -9 113S_6 /q3 Amm <br /> JO <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/WvIMP Complete and Accurate 9. Employees Familiar with HMMP r/ <br /> 4.If Business is a Hazardous Waste Generator, 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site i/ 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/ 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) ' <br /> r Ur 0-04 (6 c�c' <br /> a -Z2 <br /> lid i dyZZ <br /> )qbD was 76 -one_ — Z2 <br /> LAYSEL lminrs-a , <br /> `3 <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag SJ Env Mth ❑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 Perforating Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative Print Name and Title) Business Representative(Signature) <br /> .� 74M3u,�/ <br /> Nam n e C WHITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> CES HM 01M) <br />