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COUNTY OF SAN JOAQUIN <br />�4�Q•�a OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />r. X222 EAST WEBER AVENU; <br />STOCKTON, CALIFORNIA 95202 <br />c`� ••�.kr�� TELEPHONE (209) 468-3969 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME / �- <br />ONE NUNMER <br />BUSINESS ADDRESS (Facili YBcing`Tms d) <br />r� <br />CODE <br />rIRE Dl$$TRIC17 1 <br />r <br />INS O DATE <br />ARRIVAL TRvIE <br />DE/s' TURFLTIME <br />S OTYPE <br />j f Cc jib,t <br />ECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1, Business HMMP/Inventory On Site <br />7. Facility Map Complete and Accurate <br />2. HMMP/Map Easily Accessible to Employees <br />S. Chemical Inventory Complete & Accurate <br />3. Bus ID Page/HNEIAP Complete and Accurate <br />9• Employees Familiar with HMMP <br />10. Plant Operations Appear Safe <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site <br />1 . 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 />13. Soil and Facility Appear Nan -Contaminated <br />CONLMENTS (Items marked "NO" above must be explained in this section) <br />4'/:"it1� •i. F✓, �t:r 1 �i�il9 e / ">/. / 1.✓Ce . 'cii a r� r! <br />REFERRALS (FOR OES USE ONLY) [] SJ Ag [] SJ Env H1th [1OSHA []Fire [] Air Dist <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions Must Be Delivered To OFS 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) <br />Business RepresentAdye (Signature) <br />Name of Inspector. and Fire Company <br />/ ' , <br />3.1 .. !1 . ✓. I ._ <br />Whrm COPY: OES <br />CANARY COPY: FIRE PREVENTION <br />PINK COPY: BUSINESS <br />RIV 11/% <br />/ - 71 U <br />T NVW 8JT- <br />vi <br />T 0_deE=s <br />