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a�IN <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> cq�;Fca`' TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINES�N y� r TELEPHONE NUMBER <br /> BUSINcESS ADDRESS (Facility BeingInspected) ZIP CODE <br /> /� <br /> FIRE DISTRICTINSPECTION DA AL TIME DEPARTURE TIME INSPECTION E <br /> 10,130 � s_ V /; <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 /> C L4 /I A d-C el 5L LI) <br /> /i a d r — L V, T <br /> CdQf CE ,!1 <br /> v,, 1 / YY <br /> a � 4 <br /> n <br /> V� /N <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 /> ACKNOWLEDG ENT OF REVMW MD RECEIPT OF INSPECTION RESULTS <br /> Business Represe ,r d le) BY��jes6we(Signature) <br /> Name spectot and F- a ompany w COPY: OES <br /> CAN Y COPY: FIRE PREVENTION REV 11/96 <br /> 4_1 L PINK COPY: BUSINESS <br /> OES-HM 1(11/96) <br />