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t <br /> COUNTY OF SAN JOAQUIN 4=: <br /> OFFICE OF EMERGENCY SERVICES AUG 9 h Min <br /> ,{ ROOM 610,COURTHOUSE -; •i _, E. .. '.� <br /> t 222 EAST WEBER AVENUE <br /> r STOCKTON, CALIFORNIA 95202 <br /> -£fit RS1y� HAZARDOUS MATERIALS(09) DIVISION (209)468-3969 <br /> 015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> Bp4MSS NAME TELEPHONE NUMBER <br /> \ <br /> BUSINESS ADDRESS Pacility eing Inspected) <br /> FIRE DISTRICT INSIVCTION DATE ARRIVAL TIME DEPARTURE TIME INSP CTION TYPE <br /> kk o <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site 7.Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employee ✓ 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/I-IMMP Complete and Accurate 9. Employees Familiar with HMMP (/ <br /> 4. If Business is a Hazardous Waste Generator, 10.Plant Operations Appear Safe L� <br /> are Hazardous Waste Manifests On Site? 11.Hazardous Materials Being Properly Handled by Employee <br /> 5. Material Safety Data Sheets (MSDS) On Site 12.Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Han W, 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explained in this section) <br /> , t r <br /> 8 <br /> REFERRALS ❑ SJ Ag ❑ SJ Env Mth ❑OSHA ❑Fire ❑DA ❑ <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) Bu2s Representative(Signature) <br /> Na of I pec A nc Fire Co. (If Appropriate) COPY: OES <br /> PINK COPY: BUSINESS REV 9/0 <br />