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COUNTY OF SAN JOAQUITW <br />p.P4UlN'.0 OFFICE OF EMERGENCY SERVICES <br />).• •OL <br />ROOM 610, COURTHOUSE <br />y < 222 EAST WEBER AVENUE <br />STOCKTON, CALIFORNIA 95202 <br />• i ,,, P • BUS. (209) 468-3969 FAX (209) 944-9015 <br />SINESS NAME c6"a HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />TELEPHONE NUMBER <br />BU <br />Ron's Auto Service 336-2213 <br />BUSINESS ADDRESS (Facility Being Inspected) ZIP CODE <br />25533 N. Hwy 99 Frontage Rd 95220 <br />FIRE DISTRICT INSPEC HUN DAM ARRIVAL TIME DEPARTURE TIME INS ON TYPE <br />Woodbridge -Z -d 2. 0950/0/7 HMMP <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP/Inventory On Site <br />I/ <br />7. Facility Map Complete and Accurate <br />8. Chemical Inventory Complete & Accurate <br />2. HMMP/Map Easily Accessible to Employees <br />1/ <br />9. Employees Familiar with HMMP <br />3. Bus ID Page/HMMP Complete and Accurate <br />10. Plant Operations Appear Safe <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site <br />1 t. Materials Being Properly Handled <br />5. Material Safety Data Sheets (MSDS) On Site <br />12. Materials Properly Stored and Labeled <br />6. Current Training Records On Hand <br />✓ <br />13. Soil and Facility Appear Non-Contaminated <br />I <br />COMMENTS (Items marked "NO" above must be explained in this section) <br />_# to AW NOzc � S. -S %iii/ art Ag_e__ <br />REFERRALS (FOR DES USE ONLY) 1:1 SJ Ag E]SJ Env Hlth DOSHA EjFire D 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 />Business Representative (Print Name and Title) iness semative (Signature) <br />pector acnd Fire Companyr WHITE COPY: OES <br />LNpa4me?5ICANARY COPY: FIRE PREVENTION REV 11/96 <br />hillip Cook PINK COPY: BUSINESS <br />OES - HM 1 (9/00) <br />