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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> bpiROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> d \,.. HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Lodi Airport 369-9126 <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> 23987 N. Hwy 99 <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME 1INSPECTIONTYPE <br /> Woodbridge -1Z-63 1 x/00 1 11D ), IMP <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 V1 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/IIMMP 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? N/ 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 /Y 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO",above must be explained in this section) <br /> �1f �7 S�S �VI IrV i�C�� /ywSS l <br /> 116f, kff a eve <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 /> ACKNOWLEJDOMENT OF REVIEW ND RECEIPT OF INSPECTION S <br /> Business Rtwtative(Print Nam d Title) Busi s e r native(Signature) <br /> Name of Inspector Agency Fir o. (I ppropriate) WHITE COPY: OES REV 9/02 <br /> Philli Cook PINK COPY: BUSINESS <br />