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COUNTY OF SAN JOAQUIN <br /> OP`4UlN' C OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> w� < 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> • c.., P• BUS. (209)468-3969 FAX(209)9449015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Youngs Lockeford Payless Market 727-5551 <br /> BUSINESS ADDRESS(Facility Being inspected) ZIP CODE <br /> 18980 N. Hwy 88 95237 <br /> FIRE DISTRICT INSPECTION DATE ARRIVALTIME DEPARTURE TIME INSPECTION TYPE <br /> Mokelutnne 6-29-01 OZS 1041b HMMP <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 /> 8. Chemical Inventory Complete&Accurate <br /> 2. HMMP/Map Easily Accessible to Employees <br /> HMMP V9— <br /> 3. Bus ID Page/HM1MP Complete and Accurate Employees Familiar with <br /> 4.If Business is a Hazardous Waste Generator, I0.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site /t/ 11.Materials Being Properly Handled <br /> 5. Material Safety Data Sheets (MSDS)On Site 12.Materials Properly Stored and Labeled <br /> 13.Soil and Facility Appear Non-Contaminated <br /> 6.Current Training Records On Hand <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> _ S ALo_Xipi S 077 S.--jr <br /> ,,, 2Al <br /> B - 2- <br /> REFERRALS <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 /> '7-i 2 0/ <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) BuBiness Represe ive(S' n ) <br /> OES <br /> Name of Inspector and Fire Company WHITE COPY:PY FIR <br /> CANARY ENTION <br /> Phillip Cook PINK COPY� BUSINESS REV I IN6 <br /> OES-HMI (9=) <br />