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Pg 1N COUNTY OF SAN JOAQUIN <br /> X, OFFICE OF EMERGENCY SERVICES <br /> a' y ROOM 610,COURTHOUSE <br /> c: a <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> rFOR�+` TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSFgESS NAME TEI.EPHONE NUMBER <br /> Vekepoloal - 6 0 <br /> BUSINESS ADDRESS(Facility Being(Inspect ZIP CODE <br /> 1 11&"$4 1 eC <br /> FUZE DISTRICT INSP NDATE ARRIVALTfME DEPARTURETIME INSPECTION PE <br /> CClef <br /> G i <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 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> B G <br /> 4 Ol LLQ F / / - r O_ <br /> On i .7 'c <br /> //•�ClK/ <✓T �m,o�v�PJ <br /> /0o / c <br /> i�7C Ay, no Zi6 /!7a>/Pi <br /> 6&6a .ac�e���.d �� S��in.o Zoo 6e n B�'Gfio�2•eo/ <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 DES 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) Business Represe tive(Signature) <br /> S-mvE PAPP 6,1 AA-,VAC&A2 <br /> Name of Inspector and Fire mpanWHITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> i PINK COPY: BUSINESS <br /> OES-HM 1111M) <br />