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COUNTY OF SAN JOAQU117 <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON CALIFORNIA 95202 <br /> r`1'0 HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> d FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Er—,( <br /> �aliq J T rave <br /> BUSINESS ADDRES (Fa ji1ty Being Inspected)4r fl C� <br /> FIRE DISTRICT INSPECTION DATE ARRIVALrT1 DEPARTURE TIME INSPECTION TYPE <br /> U-M /n <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMPIInventory On Site 7.Facility Map Complete and Accurate <br /> 2.HMMP/Map Easily Accessible to Employees Pf 18.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/HMMP Complete and Accurate A 19. 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? 11.Hazardous Materials Being Properly Handled by Employees <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 /> U4rd�a <br /> Jaw ✓ <br /> �r <br /> � c t4 <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Cons Must be Delivered to OES By Fellow Up Inspection Date OES Inspector Name Performing Follow Up <br /> 01,1k, c <br /> ACOWLF,DGE44ENT OF REVIEW AND RECEIPT OF INSPECTION RESUL <br /> Bus' ess Re It tive{�itme and Title Business Re se ive.(Signature)zll <br /> Aw <br /> �rDo . <br /> a e of ns c l 4 ' Agency Fire Co. (If Appropriate) WHITE COPY: OES <br /> PINK COPY: BUSINESS REV 9102 <br /> i <br />