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Ah <br />fik <br />RA4.N. COUNTY OF SAN JOAQUIN <br />a4�a•£o OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />° 222 EAST WEBER AVENUE <br />STOCKTON, CALIFORNIA 95202 <br />�r TELEPHONE (209) 468-3969 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUS SNAME <br />XiI A!:rev ' <br />TELEPHONENUM13ER <br />3(a6- <br />BUSINESS ADDRESS (Facility Being Inspected) <br />zss�3 ,✓ �w •�� �i f4e�,Po <br />ZIP CODE <br />9saz� <br />FIRE DISTRICT <br />INSPECTION DATE <br />7 <br />JARRIVALTIME <br />DEPARTURE TIME <br />� <br />INSPECTION TYPE <br />4 <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP/Inventory On Site <br />7. Facility Map Complete and Accurate <br />2. HMMP/Map Easily Accessible to Employees <br />-8 --Chemical Inventory Complete & Accurate <br />3. Bus ID Page/IIMMP Complete and AcSWAW <br />9. Employees Familiar with HMMP <br />4. If Business is a Hazardous W enerator, <br />are Hazardous Waste tfests On Site <br />10. Plant Operations Appear <br />11. Materials Bei operly Handled <br />5. Materia ata Sheets (MSDS) On Site12. <br />M s Properly Stored and Labeled <br />6. Current Training Records On Hand <br />I T3—. Soil and Facility Appear Non -Contaminated <br />COMMENTS (Items marked "NO" above must be explained in this section) <br />Busln"s kA1S_ ©t/&- 65 L <br />REFERRALS (FOR OES USE ONLY) ❑ SJ Ag ❑ SJ Env Hlth E] OSHA Fire ❑ Air Dist <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions Must Be Delivered To OES By <br />l -2_S S7 <br />Follow Up Inspection Date <br />OES Inspector Name Performing Follow Up <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION <br />RESULTS <br />Bust ess Representative (Print Name and Title) <br />h ier <br />Bu?*rs Representative (Signature) <br />/` ' <br />N ti <br />wHfvrfE COPY: OES <br />CANARY COPY: FIRE PREVENTION <br />PINK COPY: BUSINESS <br />REV 11/96 <br />OES HM t (11M) <br />