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COUNTY OF SAN JOAQUIN <br /> U ' <br /> OFFICE OF EMERGENCY SERVICES 4---- - <br /> ` < ROOM 610,COURTHOUSE ����lpp <br /> 222 EAST WEBER AVENUE �'�tlt 3 0 2000 <br /> =a STOCKTON, CALIFORNIA 95202 <br /> ��IiFoaN' TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESSjV p ER <br /> % <br /> BUSINESS A RESS(Facility Being Ins ected) ZIP CODE <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME I INSPECTION TYPE <br /> �7-oo /�,'fa Y S" <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 v <br /> 2. HMMP/Map Easily Accessible to Employees 8. Chemical Inventory Complete&Accurate r/ <br /> 3.Bus ID Page/HMMP Complete and Accurate 9. Employees Familiar with HMMP <br /> 4.If Business is a Hazardous Waste Generator, [E 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 1 112.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 1 113.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <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 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) Busines ature) <br /> N e of Inspecto and Fire Company WHITE COPY: OES <br /> t CANARY COPY: FIRE PREVENTION REV 11/96 <br /> �A PINK COPY: BUSINESS <br /> L 41A OES-HM1(1 11N) <br />