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r <br /> � = r+ COUNTY OF SAN JOAQUIN <br /> "_- OFFICE OF EMERGENCY SERVICES FEB - 2 2005 <br /> ROOM 610,COURTHOUSE SAN OFFICE OF EMERGENCY QUIN SERVICES <br /> 222 EAST WEBER AVENUE <br /> y� STOCKTON, CALIFORNIA 95202 <br /> 9{r yH N HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Auto Zone 824-9665 <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> 147 S. Main Street, Manteca, CA 95336 <br /> FIRE DISTRICTINSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> 24 /- 2'�- OS //.too /Z ! 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 <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 V 12.Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand ✓ 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Itemsmarked"NO"above must be explained in this section) <br /> p� QQ O0 <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 /> Business Representative(Print Name and Title) Business Re ese e(Sig ure) <br /> CAA yIPY At-It? 2 <br /> Name of Inspector Agency Fire Co. (If Appropriate) WHITE COPY: OES IREV 9/02 <br /> PINKCOPY: BUSINESS <br />