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dh <br /> COUNTY OF SAN JOAQUIW <br /> op4�1 N c OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 0: s 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> �'<iFORa:r BUS. (209)468-3969 FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> 931-3093 <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 4907 E Waterloo Rd 95215 <br /> FIRE DISTRICT INSPECTION DATE ARRIVALTIME DEPARTURE TIME I INSPECTION TYPE <br /> Waterloo Morada 0-1q-0Z 0556 QIP <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 <br /> 3. Bus ID Page/HMMP 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 11.Materials Being Properly Handled <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 /> / L <br /> -TD BZ — 2 —0Z_ <br /> REFERRALS (FOR OES 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 /> $- z(. -a Z <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Busin s Representative(Print Name and Title) Busine Representative(S' nature) <br /> �Gvt <br /> Name of Inspector and Fire Company WHITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> Phillip COOK PINK COPY: BUSINESS <br /> OES-HMI (9/00) <br />