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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> iRl9i 222 EAST WEBER AVENUE <br /> s►� .eik' STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS RIMS N(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> q3/ - 397 <br /> BUSINESS ADDRESS tFacility Being Inspected) <br /> 3Zto /v AOA-g7 B- 1 <br /> FIRE DISTRICT INSPECTI N DATE JARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> O S7- )eo,,A x•169 <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. HMMP/Map Easily Accessible to Employees 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/HMMP Complete and Accurate V 19. 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.Hazardous Materials Being Properly Handled by Employee <br /> 5. Material Safety Data Sheets(MSDS)On Site 12.Hazardous 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 /> 4 S. <br /> y/ <br /> / we 0-W <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire [IDA <br /> ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions ust be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> -71, s <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULT <br /> Business Re'g , tative(Print Name and Business Re se ry ignature) <br /> D014 ,117` ); t <br /> Name o Ins nc r Fire Co. f Ap opr' te) WHITE COPY: OPS REV 9/02 <br /> y tTJ w D PINK COPY: BUSINESS <br /> p <br />