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AZCO UNTY OF SAN JOAQUIN <br /> 'ICE OF EMERGENCY SERVICES <br /> Robert Arnarante ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> fOCKTON, CALIFORNIA 95202 <br /> TELEPHONE(209)468-3969 <br /> 250 Stewart St., H9 209-943-2452 t4ATERIALS PROGRAM INSPECTION FORM <br /> 3tockton, CA 95205-3244 FAX 209-943-0437 TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIPC DE <br /> L2 94 <br /> 9 <br /> FIRE DISTRICT // � INSPECI7ONDATE ARRIVALTIME DEPARTURETIME I WSPECTIONTYPE <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 <br /> 5.Material Safety Data Sheets (MSDS) On Site 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 /> s' <br /> /i O cllev 9 Z71Z C el- '-V e-, <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag [--ISJ Env Hlth OSHA [:] Fire [7Air Dist ❑ <br /> INSPECTION FOLLOW Up INFORMATION <br /> ,ortective Actions Must Be Delivered To OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> KNOW[EDGEMENT OF REVIEW AND RECEIPT OF INSP&gIION RESULTS <br /> ness Representative(Print Name and Title) BusmW Representative(Signature) <br /> iftrT AMARAW-ky, 00QE <br /> if Inspector and Fire C pa WHITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> 0 PINK COPY: BUSINESS <br /> OEs�HM 10I iM) <br />