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COUNTY OF SAN JOAQU <br /> OFFICE OF EMERGENCY SERVICES <br /> r.` y ROOM 610, COURTHOUSE <br /> a`i < 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> • c,�iFoa'vP BUS. (209)468-3969 FAX(209)9449015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Linden Unified - Waterloo School 931-0818 <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 7007 N. Pezzi Rd 95215 <br /> FIRE DISTRICT INSPE"ONDATE ARRIVALTIME DEPARTURETIME WSPECfIONTYPE <br /> Waterloo Morada _Z[Is Cj j� C,94fs—o C HMMP <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> I. 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, j�— 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site 11.Materials Being Properly Handled f <br /> 5. Material Safety Data Sheets (MSDS)On Site 12.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> # 3 W&RIO TimF jfeE <br /> - va_ <br /> REFERRALS (FOR DES USE ONLY) [:]SJ Ag ❑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 /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> mess Representative(Print Name and Title) Busines Representati r(Signature) <br /> Q <br /> Nalne of Inspector and Fire Company WRITE COPY: OES <br /> Phillip Cook PINK CANARY <br /> COPY: FIRE BUSINESSENTION REV 11/96 <br /> OES-HM 1 (9/00) <br />