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RU1N COUNTY OF SAN JOAQUIN <br /> s� .coc OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> si x 222 EAST WEBER AVENUE <br /> •' _ STOCKTON,CALIFORNIA 95202 Jul <br /> c�•: g:" TELEPHONE(209)468-3969 <br /> G%ppp <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONENUM13ER <br /> 1�': R VI Nr Solo - I.DG 11 -f�11 <br /> BUSINESS ADDRESS(Facility Being Inspected) 21PCODE <br /> rN3 3 S- q s Q. .S!:), O <br /> FIRE DIS ICI• INSPECTION DATE ARRIVAL TIME DEPARTURE TDAE INSPECTION TYPE <br /> EJ g 10 S"vu e 8 I / lJ ikmrelto <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 yL <br /> 3.Bus ID Page/HMMP Complete and Accurate9. Employees Familiar with HMMP <br /> 4.If Business is a Hazardous Waste Generator, 10.Plant Operations Appear Safe �A, <br /> are Hazardous Waste Manifests On Site 11.Materials Being Properly Handled <br /> 5.Material Safety Data Sheets(MSDS)On Site r>c 112.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand I y, 113.Soil and Facility Appear Non-Contaminated }l\ <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> O <br /> REFERRALS (FOR OES USE ONLY) SJ Ag E]SJ Env Hlth []OSHA Fire ❑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 /> ;Z0 S v <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTIO ULTS <br /> Business Representative(Print Name and Title) Bus' ss ve(Si ture) <br /> Name of Inspector and Fire Company WHITE COPY: OPS <br /> P CANARY COPY: FIRE PREVENTION REV 11196 <br /> PINK COPY: BUSINESS <br /> OES-HM 1111/88) <br />