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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> e: 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> �'�Yi'r SH•I''C� TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BU/SI-NESS NAME TELEPHONE NUMBER <br /> 4W,46FGle S?.eii✓�S CmcF Ctxt,QS� 333-6Z7.r- <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIPCODE <br /> I(b 3W AA yu/ 88 95zyo <br /> FIRE DISTRICT' INSPECIION DATE ARRIVAL TIME DEPARTURE TIMEINSPECr10N TYPE <br /> oI:EULwL„ff <br /> 11-7-7-7 08 3s” 000 M/ ,On <br /> INSPECTION RESULTS <br /> DOCUMENTREVIEW 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 Nf 11.Materials Being Properly Handled <br /> 5.Material Safety Data Sheets(MSDS)On Site I/ 12.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand oil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> �u Siy,ess [SOCZ . r Vizi /9 �u6av <br /> s a <br /> =9 01012SI& <br /> enuzv2 — A,Q//lo 7 fo A0 pins <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag [:]SJ Env Hlth OSHA Fire F]Air Dist <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must Be Delivered To OES By Follow Up Inspection Date OES Inspector Name P rming Follow Up <br /> II- t8.q <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Repr tative_(Print Name and Title) Busine Represep$tive(Signature) <br /> i h 1 y // <br /> ( C Su llH/e�1/t4�17 <br /> N n CANARYOPY: OES <br /> COPY: FIRE PREVENTION <br /> REV 11/96 <br /> PINK COPY: BUSINESS <br /> OESMMi 111/88) <br />