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COUNTY OF SAN JOAQUIN <br /> �..�•,oG OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> cq�/koaN�� TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME (� TELEPHONE NUMBER <br /> l_ Ji 1 it�sk— ,-, 0Z_ � <br /> BUSINESS ADDRESS(Facility Being Inspected) CODE <br /> C) 8' l,��-E- cJ1 W5 2-0,S- <br /> FIRE DI TRICT INSPECTION DATE ARRIVAL DEPARTURE TIME I VECT[ON TYPE <br /> C <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1. Business HMMP/Inventory On Site J8. <br /> . Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees Chemical Inventory Complete&Accurate <br /> 3.Bus ID Page/HMMP Complete and Accurate . 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 /> 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) Business Representative(Signature) <br /> Name of Inspector and Fire Company WHITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> O PIT PINK COPY: BUSINESS <br /> OES-HM 1(11/96) <br />