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J <br /> n✓ <br /> as ,:;w ~COUNTY OF SAN JOAQUINd`��r�'�' <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE JUN 2 t 2004 <br /> 222 EAST WEBER AVENUE Sf169 YV r. ua� UUi9lY <br /> STOCKTON, CALIFORNIA 95202 "Wit,.OPEi11ERGEWYSERVICE <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> - FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Wcv_ �a\�-SGS GovF cc�cz <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> `I \I CaD a5 � <br /> FIRE DISTRICT INSPECTION DATE rRtRIIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> 5 %X)tNI? <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION 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 and 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? t1 11.Hazardous Materials Being Properly Handled by Employee <br /> 5.Material Safety Data Sheets (MSDS) On Site 12.Hazardous 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 /> J -�MivOt2:,S o C\ <br /> REFERRALS ❑SJ Ag ❑SJ Env HIth ❑OSHA ❑Fire ❑DA ❑ <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 SULTS <br /> Business$eppresentafive(Priut Name and T1 C) Bu iness ep n lure) <br /> Name of Inspector Agency Fir o.(If Appropriate) WHITE COPY: OES <br /> DEi-amu\S JEAJJ . ��p.A�C . 'Dk5qj � I PINK COPY: BUSINESS V 9/0 <br />