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COUNTY OF SAN JOAQUIN <br /> a° �o OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> r, < 222 EAST WEBER AVENUE <br /> .�. MAY -- ti iJ:;, <br /> STOCKTON,CALIFORNIA 95202 <br /> �•�Yi•'pH's'~• TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION ORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Costa's Machine 823-0781 <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 272 Button Avenue 95336 <br /> FIRE DISTRICT INSPEFnON DATE ARRIVAL TIME DEPARTURE TIME INSPE�{�ON TYPE <br /> 24 y-�2 95 13a � 1s� Inn <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/HIvIMP 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 �V/ 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 /> �l r`M � Ce! raS 4 I \ � 10 1.� C_�• V` A <br /> \ \ L <br /> c_6 Aa <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 Representa • (Sig azure <br /> CoAptV W 1\Ccl �I\t\1\ t'V <br /> Name of Ins ector and Fire Company WHITE COPY: OES <br /> \ CANARY COPY: FIRE PREVENTION REV 11196 <br /> �-1 — PINK COPY: BUSINESS <br /> OS HMI(11M) <br />