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Ah <br /> PQU1H <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> +" TELEPHONE(209)468-3969 <br /> ciFp"ryN <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME/'� ' / / '�� TELEMONEM2/� <br /> BUSINESS ADDRESS(Facility Being Ins cted) F/_ ZPCODE <br /> deo S, wZ <br /> FIRE DIS CTINS DA ARRIVAL DEPARTt1RETIME INON TYPE <br /> rS o 00 0 2Ar/vl #:?sr P/4, <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, .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 L113.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section)/ <br /> t^6 7i,i S ) 2 / rY <br /> ,} / 2 <br /> LL / / / <br /> 'lr !Lr i1 Q -0— F {t r! <br /> a <br /> 'd e <br /> LCL I ,/— <br /> tt- 7 1�0 va 9 o 4- <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag ❑SJ Env Hlth [-]OSHA Fire ❑Air Dist <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Ac 'ons Mus Be Delivered To OES By Follow U Inspection Date DES Inspector Name Performing Follow Up <br /> ZS O O <br /> c1 Oc 20QQ <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Busines epresentati Sign <br /> ,AkJE <br /> Name of Inspector and Fire Company WHITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> OM HM1(11188) <br />