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! • <br /> COUNTY OF SAN JOAQUIN RECEIVED <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE NOV 16 M <br /> 222 EAST WEBER AVENUE SAN JOAQUIN COUNTY <br /> / STOCKTON, CALIFORNIA 95202 OFFICE OF EMERGENCY SERVICES <br /> Qb ,� HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Jiffy Lube 239-0665 <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> 1130 N. Main Street <br /> FIRE DISTRICT INSPECTION DATE JARRIVAL TIME IDEPARTURETIME 1INSPECTIONTYPE <br /> 24 I I—1p-Olo HH14P <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 <br /> 3.Bus ID Page/1IMMP 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 Employee <br /> 5. Material Safety Data Sheets(MSDS)On Site 112.Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand <br /> 113.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 lip <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Replesentative(Si ature) <br /> 41Name of Insp r Ag cy r Fire Co. If propriate) WHITE COPY: OES REV 9/02 <br /> Ke Ar\ <br /> G Ct:'Pn 1— i PINK COPY: BUSINESS <br />