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413�s9 <br /> COUNTY OF SAN JOAQUIN <br /> " war- <br /> OFFICE<Y; OF EMERGENCY SERVICES RECEIVED <br /> ROOM 610,COURTHOUSE <br /> OilDECt .-,, r1005 <br /> �. 222 EAST WEBER AVENUE l� 1 L <br /> STOCKTON, CALIFORNIA 95202 SAN JOAOUIN COUNTY <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 OFFICE OF <br /> FAX(209)944-9015 EMERGENCYSERVICES <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Quick Stop 239-2957 <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> 1196 W. Louise Avenue <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> 24 - 01 14 ZS /'f .'S� HMMP <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 X <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? 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 /> 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 Representative(Print Name and Title) Business Repres ntative(Signature) <br /> eY <br /> Name f Inspector Agency Fire Co. If Appropriate) WHITE COPY: OEs <br /> 7REV 9/02 <br /> t PINK COPY: BUSINESS <br />