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COUNTY OF SAN JOAQUIN <br /> a4!R So OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> mi <br /> P. " 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> TELEPHONE(209)468-3969 <br /> �1FCR <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> G-I-G_ IJ SE Jc CCN 2 842- iqco <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIPCODE <br /> L4&+o W OS-r- L^t-,SF- 95204 <br /> FIRE DISTRICT' [NSP ONPATE ARRIVAL TIME DEPARTURE'lU INSPECTION TYPE <br /> 5Toc1 Kron) i z��/q4 I3aa �t P <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1,Business HMMP/Inventory On Site t/ 7. Facility Map Complete and Accurate <br /> 2,HMMP/Map Easily Accessible to Employees 8. Chemical Inventory Complete&Accurate <br /> 3.Bus ID Page/1-IMMP 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 112.Materials Properly Stored and Labeled ✓ <br /> 6.Current Training Records On Hand 113.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> 3 N 0,W&C �PG+ �s nJ me Parc�ss) <br /> REFERRALS (FOR OES USE ONLY) SJ Ag E]SJ Env Hlth OSHA Fire �Air Dist ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Mu t Be Delivered To UES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> _.0CC_.131 Igt49 <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) iness Representative(Signature) <br /> lV J ENvlh� >± n� �m.ls <br /> Name of Inspector and Fire ompany WHITECOPY: OEs <br /> ` 1'l G� 1 CANARY COPY: FIRE PREVENTION REV 11/96 <br /> Dp Sc"C—C,5 twikk, ..JN.1.t'16° G IIJ� �� —g G� PINK COPY: BUSINESS <br /> OES-HM 1(1 IM) <br />