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/ � (P t <br /> COUNTY OF SAN JOAQUIN 'RECEIVED <br /> OFFICE OF EMERGENCY SERVICES NOV <br /> .r ROOM 610,COURTHOUSE N O V 2 6 LOouC <br /> 222 EAST WEBER AVENUE -'Aly JUAUUIN UUUN I Y <br /> P STOCKTON, CALIFORNIA 95202 OFFIC20FEMERGENCYSERVICES <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Speedee Oil Change and Tun DP <br /> 825-5823 <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> 245 W. Louise Aveni n <br /> FIRE DISTRICT INSPECTION DATE JARRIVALTIME DEPARTURE TAIE JINSPECTIONTYPE <br /> I� j 00 > ' <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 ti <br /> 2. HMMP/Map Easily Accessible to Employees 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/HMMP Complete and Accurate y 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 Employee <br /> 17 <br /> 5.Material Safety Data Sheets (MSDS)On Site L7 12.Hazardous Materials Properly Stored and Labeled . <br /> 6.Current Training Records On Hand I 1 113. Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explained in this section) <br /> n A W L <br /> REFERRALS ❑SJ Ag ❑SJ Env Mth ❑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'Representative(Signature) <br /> Name of Inspector Agency Fire Co.(If Appropriate) WHITE COPY: OES <br /> C_ PINK COPY: BUSINESSV 9/02 <br /> f <br />