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COUNTY OF SAN JOAQUIN <br /> O.t`4Ul NAC OFFICE OF.EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> ^: < 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> `•. P BUS. (209)468-3969 FAX(209)944-9015 <br /> 4G%PORN <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS S"� AME t TELEPHONE NUMBER <br /> l� ewe SCG r g43 �7(f? P <br /> BUSINESS ADDRESS(Facility Being Inspected) / ZIPCODE <br /> '713- P A✓ Q-0 4 tZ T a<<.,,, 9 S-2 0 3 <br /> FIRED STRICTPE O TE ARRI ALTIME PARTURE TIME INS ON E / <br /> S 7 2/ o /X 00 /5<.3 -a.- c C_ <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1. Business HMMP/Inventory On Site . 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 t� <br /> 5.Material Safety Data Sheets (MSDS)On Site 12.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 /> X 5r— n o.. P"s-'o 1w✓: �� 1c <br /> f( - 6., AaIAr a2/ 02ed? <br /> i i n e ✓�... s_ Zoo.7 _ <br /> 4CHEMSTATIM <br /> MArrHEW H. MASCARA <br /> Mailing: Rough&Ready Island 11 A <br /> REFERRALS (FOR OES USE ONLY) SJ Ag SJ Env Hlth Stockton, CA 95203 <br /> Planh Rough & Ready Island (209( 943-7478 <br /> INSPECTION FOLLOW UP INFORMATION 713-E Luce Ave. Fax(209( 943-7479 <br /> Come liveAction Must Be Delivered To OES By Follow Up Inspectic Stockton,CA 95203 mmascara@chemstation.net <br /> flu ur 2- 2ooa <br /> ACKN WLEEIGEMIAT OF REVIEW AND RECEIPT OF INSPECTION RESULTS If <br /> Business sent ve.(Prin[ arae and Title) Business tativ ignature) <br /> att� nand Fire COmpany� WHITE COPY: FIR <br /> / Cz /•{. CANARY COPY: FIRE PREVENTION REV 11/96 <br /> '42 '� 0 PINKCOPY: BUSINESS <br /> OES-HM 1 (9100) <br />