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Pqu�N COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> �Oi iFo"aN TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> OCR /cLtIJG S (7 <br /> BUSINESS ADDRESS (Facility Being Inspected) ZIP CODE <br /> 3 RI t /�l�vc� - 2v - yav <br /> FIRE DISTRICT INSPECTTONDATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> ( Y©o p <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 V <br /> 5.Material Safety Data Sheets (MSDS) On Site 12.Materials Properly Stored and Labeled ✓ <br /> 6.Current Training Records On Hand 1/ 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> N 6 p t02 <br /> > C4j � a <br /> L <br /> �SLu 4 <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag SI 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 RE ULTS <br /> Business Representative(Print Name and Title) Busine a entative(Signature) <br /> Pg i- zvo T S� <br /> Name of Inspector and Fire Company WHITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> OES-HM 1(11IN) <br />