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05/11/2005 11:17 FAX 209 932 0610 R&B VUNSTRUUFIUN tgjuu9 <br /> COUNTY OF SAN JOAQUIN <br /> T; <br /> OFFICE OF EMERGENCY SERVICES RECEIVED <br /> + u ;LOOM 616•COt1RTHOIISE <br /> 222 EAST WEBER AVENUE MAY 11 200 <br /> STOCKTON• CALIFORNIA 95202 OFFIsAN.i0A0UIN000N_, <br /> '�+ • •• ••::`} HAZARDOUSMATtlUALSDIVISION(209)169-3969 CEOFEMERGENCY S. <br /> .r'apM- FAX(209)9149015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BU,IN6SSNAME TE`L'EPHONE NUMBER <br /> as c <br /> -72 <br /> BUSINESS ADDRESS(Facilit Being Inspected) <br /> �. S. 99 <br /> FIRE DISTRICT I PON TE IVAL TBdE DEPARTURE TIME INSPECTION TYPE <br /> f� tu� g z .6 0� 3 (p�rPL1�nP <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.IIMMP/Map Ewly Accessible to Employees R.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/H~Complete and Accurate 9.Employees Familiar with HMMP <br /> !.If Business is a Hazardous Waste Generator. 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site? 1I.Flumdous Materials BeingProperly Handled E to <br /> 5.Material Safety Data Sheets(MSDS)On Sttc 11 Hazardous Materials Properly Stored and 1 abeled <br /> 6.Current Training Records On Hand 13.Sal and Facility Appear Non-Contaminated <br /> COMMENTS(hems marked"NO"above must be explained in this seetion) <br /> 500 <br /> LOG C . I_ ACf{ G ¢�r . <br /> REFERRALS 0S Ag ❑S3Env Hlth ❑OSHA ❑Fire [IDA ❑ _ <br /> INSPECT•ON FOLLOW UP 04MRMATION <br /> Corrective Actions Must be Delivered to OES By Fellow Up Inspection Date ORS Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION TS <br /> BuuuFw+ senmtive(Print Nara and Title) Bust i n ) <br /> n b wn1,r' � ? <br /> ame mr t/ Fire Co. <br /> coo® NOI.IDIIWSNOO 911111 or99 zte fog ivair"ii 9009/10/to <br />