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A Aft <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> :a ROOM 610, COURTHOUSE <br /> 0: ' 222 EAST WEBER AVENUE <br /> _ STOCKTON, CALIFORNIA 95202 <br /> °' • :° BUS. (209)468-3969 FAX(209)944-9015 <br /> ,tiboa:+ <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINFSS NAME TELEPHONE NUMBER <br /> 1A6v &at -t- 579 - y77- agog <br /> BUSINESS ADDRESS(Facility Being Ins ected) ZIP CODE <br /> 37Hyau. �u � 9Sai,� <br /> FIRE DI TRICT INSPECTION DATE ARRIVAL TIME DEPART E INSPECTION TYPE <br /> -1111-14 s-/o 1 9-.21- 1 q , <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/HMMP Complete and Accurate 9. Employees Familiar with HMMP <br /> 4.If Business is a Hazardous Waste Generator, <br /> 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests Or Site �I7 11.Materials Being Properly Handled L� <br /> 5. Material Safety Data Sheets (MSDS)On Site `� 12.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 113.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> COZ � �Q.`r uo� �•`r ,a,rde , Cory nl Q do Q� <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 pr sen live(Signature) <br /> Dbily lean RQsta.urdn+ many c <br /> Name of Inspector and Fire Company WHITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 106 <br /> BUSINESS <br /> OES-HMI (9/00) <br />