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Ah a <br /> COUNTY OF SAN JOAQUIN <br /> PQu�N. <br /> OFFICE OF EMERGENCY SERVICES <br /> _ ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> �`• STOCKTON,CALIFORNIA 95202 <br /> cyiieoa`'�' TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> L <br /> ,IC. <br /> BUSINESS ADDRESS/(Facility Being Inspected) ZIP CODE <br /> l 2 7V Q r <br /> FIREDISTRICr INSPECTIONDATEARRIVALTIME DEP TIME INSPECTION TYPE <br /> ra 10- 11- 4e HX/ 14t 36 11trnM <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH 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&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.Materials Being Properly Handled <br /> 5. Material Safety Data Sheets(MSDS)On Site 12.Materials Properly Stored and Labeled 25 <br /> 6.Current Training Records On Hand 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Itteems marked "NO" above must be explainedinthis section) <br /> UV CamV`mLYI <br /> �r e✓ fr � <br /> REFERRALS (FOR OES USE ONLY) SJ Ag SJ Env Hlth ❑OSHA Fire E]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 /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> BusinessZSf,-,f77- <br /> entative(Print Name and Title) Bu ' ess Represe t e(Si e) <br /> r 0401-11 <br /> ame of Inspebfor and Fire Company - WHITE COPY: OBS <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> OES HM1(11M) <br />