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Ank Ask <br /> Pa�,H COUNTY OF SAN JOAQUIN <br /> o " OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> ni ' 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> �qHSP BUS. (209)468-3969 FAX(209)944-9015 <br /> �r FaP <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONENUMBER <br /> Mc Donald's 1123653 239-3379 <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIPCODE <br /> 1236 W. Yosemite Avenue 95337 <br /> FIREDISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> 24 /� —Z9 — o ! 14 15-0 IS! / S 14-m ,t <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 Employees8. Chemical Inventory Complete&Accurate <br /> 3. Bus ID Page/HMMP Complete and Accurate _X 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 �K, 11.Materials Being Properly Handled <br /> 5. Material Safety Data Sheets(MSDS)On Site x 12.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 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 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) Bus' s Represen9�� <br /> 0AL11 p C�za, y M1W#q&F� C_ -/ e <br /> Name of Inspector and Fire Comp a wH1TE CO oes <br /> LW �Zq� LANA k FIRE PREVENTION REV 11/96 <br /> PINK OPY: BUSINESS <br /> OES-HM1 (9100) <br />