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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES RECEIVED <br /> L <br /> d` ROOM 610,COURTHOUSE 1 t 5 <br /> 1 200 <br /> 222 EAST WEBER AVENUE 1 <br /> STOCKTON, CALIFORNIA 95202 SAN JOAQUIN COUNTY <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 OFFICE OF EMERGENCY SERVIS <br /> ; �£% —'"' :•, FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Quick Stop 1124 823-7628 <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> 505 N. Main Street <br /> FRE DISTRICT INSP CTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> 24 /'/ O S` 9 : �/s.y�, 10;/U 4, >I� <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES <br /> 1. Business HMMP/Inventory On Site 7.Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees V1 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/1 MMP Complete and Accurate V1 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 V 13. 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 Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTIO ULTS <br /> Business Representative(Print Name and Title) Bunes esentative(Signa <br /> W R— S W C ,^ 4- <br /> Name of Inspector Agency Fire Co. (If Appropriate) W(BTE COPY: OES REV 9/02 <br /> p meati�r �� ��. PINK COPY: BUSINESS <br />