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COUNTY OF SAN JOAQUIN <br /> 0.p4uIN".0 OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> �q•. NyP BUS. (209)468-3969 FAX(209)944-9015 <br /> t,FGP <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> GG.e,i'q IF Vg - 6�lYa <br /> BUSINESS ADDRESS(Facility Being Inspected) DP CODE <br /> //// /1/a v 6P_ qS�6 <br /> FIRE DISTRICT INSPECTION DATEARRIVAL TIME DEPARTURE T E INSPECTION TYPE <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 ab✓` 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 L__- <br /> COMMENTS (Items marked "NO" above nmsl 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) Bu ' ess Representau (Signature) <br /> &418 wam J <br /> Name of Inspector and Fire Company WHITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> OES-HM 1 (SM) <br />