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-�3 X35 <br /> PQ�IN COUNTY OF SAN JOAQUIN <br /> o OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE UL 2 4 26U1 <br /> STOCKTON, CALIFORNIA 95202 <br /> • i - asr• BUS. (209)468-3969 FAX(209)944-9015 :fFlCEO�EPaciiu ICYSc'h'!CES <br /> �I FOR - <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Quick Stop 239-2957 <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIPCODE <br /> 1196 W. Louise Avenue 95336 <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME I WSPECTTONTYPE <br /> 24 11-10-01 1 Ogoa 1 0q MMP <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, 10.Plant Operations Appear Safe / <br /> are Hazardous Waste Manifests On Site 11.Materials Being Properly Handled / <br /> 5. Material Safety Data Sheets(MSDS) On Site / 12.Materials Properly Stored and Labeled / <br /> 6.Current Training Records On Hand 1 / 13. Soil and Facility Appear Non-Contaminated / <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> /1,001 <br /> E1ICPL WAWA of LaA' noM G)VA AMMP <br /> MWAP IS ZobO <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 U Inspection Date OES Inspector Name Performing Follow Up <br /> ry..�J•�� P 1 O <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> B siness Representative(Print Name and Title) Business Representative(Signature) <br /> k' <br /> Name of Inspector and Fire Company WHITE CANARY COPY: ORE PREVENTION <br /> -r(`-�/AI& SWT4 MED PINK COPY: BUSINESS REV II/96 <br /> OES-HM1 (9100) <br />