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Ah An <br /> mw COUNTY OF SAN JOAQUIN MR <br /> o?qu(y c OFFICE OF EMERGENCY SERVICES <br /> a '+oma <br /> ROOM 610, COURTHOUSE <br /> m < 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> c•., p• BUS. (209)468-3969 FAX(209)944-9015 <br /> �tIFORN HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME c� � rr <br /> TELE/P/HONE NUMBER <br /> CODE <br /> 66 <br /> BUSINESS ADDRESS(Faci 'ty Being Inspected) <br /> 1 T 73) WLw <br /> FIRE DIS ICT uprE ION D TE ARRIV TIME EP TIME WSP CTION TYPE <br /> C v / 00 /O FYI Jd <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 t� <br /> S. 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, <br /> 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 l2.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 13. Soil and Facility Appear Non-Contaminated 'uµ4vn <br /> COMMENTS (Items marked "NO" above must be explained in this section) L <br /> in,✓� <br /> 0 t <br /> REFERRALS (FOR DES 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 �Insectore Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Bus' ss Represen iv (Si nature) <br /> Name of Inspector and Fire Company WHITE COPY: OES <br /> ..��`Z� CANARY COPY: FIRE PREVENTION REV 11/96 <br /> Q PINKCOPY: BUSINESS <br /> CES-HM1 (9100) <br />