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r . Pr, <br />ii'' <br />COUNTY <br />'OF.SAN `JOAQUAN . Y „A, + , <br />OFFICE OF EMERGENCY SERVICES <br />•aQ �� •• o y -ROOM 610, COURTHOUSE <br />WEBER`AVENUE <br />a . < •:` 222'EAST_ <br />• �; _ STOCKTON, CAL;IEORNIA .95202t� <br />;+TELEPHONE/�09 468-3969 '', r > r , <br />HAZARDOUS -MATERIALS' PROGRAM INSPECTION; FORM <br />T jFT FpHOI� NUMBIIt <br />BUSINESS NAME <br />';:..__.. ZIP OD r r.R <br />Inspected) / <br />BUSINESS ADDRESS (Fgqty Be' <br />1NSPECII N <br />, O DA JARRIVALTIMDFPTiNIEINSP£CII //.j : D O <br />// Co -6' .. <br />INSPECTION --RESULTS_.- <br />YES, .. NO y '::FACILITY WALIfi'ITEZOUGH T" ��YES;, ANO <br />F .DOCUMENT REVIEW `" <br />7 ;Facility Map.Complete',and'Accurate. - <br />1,'Business HMMP/Inventory On Site. n �. <br />8:.:,Chemical'Inventory Complete;&Accurate t - ' <br />F ` 2: HMMP1Map Easily Accessible to Employees <br />z s 4 Lisa_ <br />9. Employees Familiar with <br />3. Bus ID Pagc&NMP Complete and Accurate 10. Plant Operations Appear Safe <br />4. If Business is a Hazardous Waste Generator,' 11: Materials Being Properly Handled :'� ' " �' �` iA_ <br />.are Hazardous: Waste Manifests On Site t <br />12.Materials Properly Stored and Labeled` <br />S:,Material Safety: Data Sheets (MSDS) On Site , <br />13. Soil and Facility Appear Non -Contaminated <br />` 6. Current.Training Records On Hand y COMMENTS',(Items, marked .,"NO".'above must'.bel: explained in this section) <br />± - ;i '} h •` 1 Z • - 4 SLC i`'� <br />y 'r 74 <br />'S`� 1Y Hyl: '`rr W <br />j l - 4 <br />-� _ . , T " y.�-pC �„�..t' l '. 4 �ri Nor !}1T�•�' - <br />- .F .y' �. �ii� :!►.�`, � 1 �. � �i77A r � aiC=�: "moi~. <br />,. . - • t. `YV � 1�'•,lg1-fid.,.. <br />i <br />r � <br />CX <br />aAa �.✓' tai T. c a T of '" <br />REFERRALS <br />FOR OES USE, ONLY) a SJ Ag SJ. Env Hlth OSHA: Fire Air Dtst ` <br />IN PECTION FOLLOW UP INFOR ATION' <br />,P <br />'ve Actions Must Be Delivered To OE <br />By �• •Follow Up Inspection Date .. OES Ins ector Name Performing Follow't <br />Corrects 1 w; <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPEBCIOI RESULTS'',,. <br />(S'gnaturc) a{y <br />Business Representative (Print Name and Title),- J , �t P • , r ��M'•�5 <br />l WHIM COPY: OES. -• •':• :' ti' %'; <br />I•(sIIrf ector d Fir CompanY­- <br />Insp.' �k CANARY COPY:' FIRE PREVENTION REQ•_ <br />(i :`�oEltl jtw i tt tf�l <br />