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QUI COUNTY OF SAN JOAQUIN••N, <br />apo pow OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE <br />"• ` _- STOCKTON, CALIFORNIA 95202 <br />C'0(jFppeN�P TELEPHONE (209) 468-3969 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME <br />orris iowA /8u 907 <br />TELEPHONE NUMBER <br />9sa-6688 <br />BUSINESS ADDRESS (Facility Being Inspected) <br />10a,5- bf/ 4 4-0 /t.0o & <br />ZIPCODE <br />9SO2_07 <br />FIRE D�IS-+TRICT <br />J foC Art <br />INSPECIYON DATE <br />51- S -Oa <br />ARRIVAL TMIE <br />j <br />DEPARTURE TIME <br />I // . YS <br />I INSPECTION TYPE <br />1waoelu10 <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP/Inventory On Site <br />Li <br />7. Facility Map Complete and Accurate <br />i <br />2. HMMP/Map Easily Accessible to Employees <br />8. Chemical Inventory Complete & Accurate <br />`- <br />3. Bus ID Page/EIMMP Complete and Accurate <br />9. Employees Familiar with HMMP <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site <br />All <br />10. Plant Operations Appear Safe <br />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 <br />13. 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 <br />Follow Up Inspection Date <br />OES Inspector Name Performing Follow Up <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative Print Name and Title) sine s Representative gnature <br />Name of Insrlector and -F1 o'mpi —y WH Y: ES <br />AR.PINK COPCOP BFIRHNPREVENTIONP�V <br />11/96 <br />MIA <br />