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Ah <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 />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME <br />?.-92,0#70-2 <br />TELYYHONE NUMBER <br />�q�3og1� <br />BUSINESS ADDRESS (F cility Being Inspected) // <br />102'.F Zj, b ' G tn" <br />ZIP CODE <br />�rszo 7 <br />FIRE DI TRICT <br />IN'Z A <br />G /App <br />AL TQvIE <br />fEV-S <br />DEPARTURE TIME <br />/ <br />INSPECT[ON�E <br />lke" i ca�Q <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1, Business HMMP/Inventory On Site <br />7. Facility Map Complete and Accurate <br />2. HMMP/Map Easily Accessible to Employees <br />8. Chemical Inventory Complete & Accurate <br />3. Bus ID Page/HMMP 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 />10. Plant Operations Appear Safe <br />11. Materials Being Properly Handled <br />5. Material Safety Data Sheets (MSDS) On Site <br />112. Materials Properly Stored and Labeled <br />6. Current Training Records On Hand <br />1 <br />113. Soil and Facility Appear Non -Contaminated <br />COMMENTS (Items marked "NO" above must be explained in this section) <br />q-0 0 / � s, as CL c t tx So 14-C. G , <br />rgu"�(�rleps,Xi <br />iq 98'. <br />REFERRALS (FOR OES USE ONLY) ❑ SJ Ag [:] SJ Env Hlth Ej 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) Busi ess Representative, Signature) <br />Name ector and ' Co pany <br />wHITE OES <br />CANARY COPY: FIRE PREVENTION <br />PINK COPY: BUSINESS <br />REV 11/96 <br />OES - HM 1 (11/88) <br />