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OUNTY OF SAN JOAQUIN Q <br /> OFFICE OF EMERGENCY SERVICES DEC 17 2003 <br /> Y{tROOM 610,COURTHOUSE c TN J0AVU'N CO'R.rW <br /> 222 EAST WEBER AVENUE ffEt FaMERGENCySEr.10E <br /> STOCKTON, CALIFORNIA 95202 <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 6 Tune Up 825-5823 <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> 245 V. Louise Avenue, Manteca, CA 95336 <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> 24 2 / U 7. . 'Si 1-`S 9A 2 SS` AA mow <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 Employee 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID PagwT vIMP Complete and Accurate tz 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 /> N7 /-- Yfn�✓ -ANG �'S 1, -e,,4LS P r 1 ' r l N 4C Q,n Oh <br /> a( r{,�✓ �k -e/`�`� 23 - 7270 <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 REVIEWMile AND RECEIPT OF INSPECTION RESULTS <br /> Business a res ntative(Print Name Busines epresenta[ive(Signat <br /> Name o Inspector geenncy Fire Co.(If Approp ate WHITE COPY: OES <br /> r- F- h t� /' > 0 FtPe. PINK COPY: BUSINESS REV9/02 <br />