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COUNTY OF SAN JOAQUIN `d <br /> OPgU1N C OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> r.' •s <br /> � .. i 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> �.c{CiFoaN,►• BUS. (209)468-3969 FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> TELEPHONE NUMBER <br /> BUSINESS NAME <br /> `� S �e # 7�BS 957- 7311 <br /> ZIP CODE <br /> BUSINESS ADDRESS(Facility Being Ins eected) <br /> .� 6/D <br /> FIRE CT <br /> INSPECI'IONDATE ARRIVAL TIME DEPARTURETIME WSPEC170N TYPE <br /> Sfoc�Fo,� 8-/s- tel ;3� o H/ti�nP <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1. Business HMMP/Inventory On Site t• 7. Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees 8. Chemical Inventory Complete&Accurate <br /> 9. Employees Familiar with HMMP <br /> 3.Bus ID Page/HMMP Complete and Accurate <br /> .� <br /> 4.If Business is a Hazardous Waste Generator, /� 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site r A— 11.Materials Being Properly Handled � <br /> 5.Material Safety Data Sheets(MSDS)On Site .IW°112.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 /> .2 60, r tzoZ� ati g , �'O wrade !L <br /> f <br /> yw <br /> �?'G ito t`ra,',.u` /.etio-ra's � �'pte . �a-•� a-r <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag SJ Env Hlth ❑OSHA Fire Air Dist <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 /> 5 .x27- o / <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Represent [ive(Print Name and Title) Business Re reseptative(Sign t <br /> ✓i,J 2 1 ►q z -n C7 L M - <br /> Name of Inspector and Ore Company wHI Co ES <br /> 1 CANAR . FIRE PREVENTION REV I IN6 <br /> PINK COPY: BUSINESS <br /> OES-HMI (aVO) <br />