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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 1t ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <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 /> Jiffy Lube 239-0665 <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> 1130 N. Main Street, Manteca, CA 95336 <br /> FIRE DISTRICT INSPECTION DATE JARRIVALTIME DEPARTURE TIME I INSPECTION TYPE <br /> 24IN-3 — a avv. Llo� tv HMMP <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/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.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 I X I 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explained in this section) <br /> #6 d d S + ow 1 —-� 3 o(,4—,— 7�o <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 REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Bu 'Hess Represent tive(Print Name and Title) Bus' <br /> Ilan nAll <br /> - -- - <br /> Na�e of Insp ctor Agency Fire Co.2If Appropriate WHITE COPY: OES �V 9/02 <br /> ,` G PINK COPY: BUSINESS <br />