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COUNTY OF SAN JOAQUIN RZ.G.,1EIVE <br /> OFFICE OF EMERGENCY SERVICES JUN L 0 2004 <br /> v, ROOM 610,COURTHOUSE <br /> UUUNII <br /> 222 EAST WEBER AVENUE ft CEOFEMEERuGENCYSE GE <br /> STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 DEhn14 fie Ids <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Ik ha Cn L(P, ri'se*_ 6orp 1.2,og.334 . 2q&q <br /> BUSINESS ADDRESS(Facility Beipp Inspected <br /> 23 Mcku We11 Lorrl.; G,ac cl 62yp <br /> FIRE DISTRICT INSPECTION DATE IA"IVILTRIE jDEP,1RTURETI1vlE INSPECTION TYPE <br /> ( � (p'g_`f' to;oo <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1.Business HMMP/Inventory On Site ✓j 7.Facility Map Complete and Accurate <br /> 2.H IMP/Map Easily Accessible to Employees vj 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 Employee ✓ <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 /> sw6 . HIAM P i s hC+ vt art -fll1'5 4,tA.to <br /> PhviC r- D t 2s <br /> is no �n r ores moor e)jI OoS1'1e 1'rl <br /> � 5 I n vwwi s. (on t n &F m0for oil waS <br /> 1" Ohslto . <br /> REFERRALS ❑SJ Ag ❑SJ Env 111th ❑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 /> IC -04 <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Busi ess Represent 've(Signature) <br /> F . 00043 1n1 G � F_PS . <br /> N 4 of Inspector Agency Fire ( Appropriate) WHITE COPY: OES <br /> ! C.S C PINK COPY: BUSINESS REV 9/0 <br />