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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> G xAo 14 p 0 Co L_.Fy 2-09- 9rz-7/1 <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> 3_579 E �M G rocLc <br /> FIRE DISTRICT INSPECTION DATE JARRIVALTIME DEPARTURE TIME 1INSPECTIONTYPE <br /> e',!Zr TA9 <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 Empl 8.Chemical Inventory Complete and Acc <br /> 3.Bus ID Page/HMMP Comp15 Accurate 9. Employees Familiar with Hwfm <br /> 4. If Business is a Hazaz s Waste Generator, 10.Plant Operations ear Safe <br /> are Hazardou aste Manifests On Site? 11.Hazardou aterials Being Properly Handled by Employee <br /> 5. Mater'*Safety Data Sheets(MSDS) On Site 12.Haiedous Materials Properly Stored and Labeled <br /> 6. rrent Training Records On Hand I 113.4cil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) <br /> �-f-yi <br /> QiDe-r✓ ,S/3 ) <br /> 42/s_0 ib GoL <br /> 00 5 O zx s-0 is <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑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 RESULTS <br /> Business Representa -ye(Print <br /> ^Naame and Title) Bus' Repres tative( 1 nature) <br /> Name of Ins ector — Agency Fire Co. (If Appropriate WHITE COPY: OES <br /> L , LLC zY/ 45`Cs I PINK COPY: BUSINESS FREV 9/02 <br />