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COUNTY OF SAN JOAQUIN`1 <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> *f • STOCKTON, CALIFORNIA 95202 <br /> ,p'tl,' HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> �/I_ _0� 0­7- -73 iY <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> a" *- fN� / �7 <br /> FIRE DISTRICT INSPECTION DATE JARRIVALTIME DEPARTURE TIME INSPECTION TYPE <br /> oy v le%"Ac� <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, <br /> 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 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) <br /> O�'✓ ihJ' cc-PS'3a•-• 1=�3 —L1-y � �p=a.�-.,. <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 Fol low Up <br /> y=a3 _ o <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Businessrese a(Signature) <br /> 5AVY NO <br /> Name of Inspector Agency �^ Fire Co. (If Appropriate) WHITE COPY: OES REV 9/02 <br /> ��,fde/PFDfG�-: r/e ACS., PINK COPY: BUSINESS <br />