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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> o{' `�• TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS S NAME <br /> TELEPHONE NUMBER <br /> `del 7�.LC n r car <br /> BUSINESS DRESS(Facility Being Inspected) ZIP CODE <br /> FIRE DISTRICTINSPECTTIME <br /> ION DATE ARRIVAL R TVvlE INS ON TYPE <br /> 10 <br /> 0 -� 9 _ 4 lDEPA ( i11 <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, 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 <br /> 12.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand I3. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> re.m.w.ry F <br /> ulr u <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) Business Representative nature) <br /> lM C l 1(/ 2 <br /> Name of Inspectpr and dire Company ITE COPY: OPS <br /> // CANARY COPY: FIRE PREVENTION REV 11/96 <br /> 7^G PINK COPY: BUSINESS <br /> OES MM I(111W <br />