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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> r. 222 EAST WEBER AVENU9 <br /> STOCKTON,CALIFORNIA 95202 <br /> a�•- Ja ��� TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESSNAME �1 ^� <br /> ry[� / j/ , oNE 'MBER <br /> BUSINESS ADDRESS(FacilitvBcing-Ins c d) LF CODE <br /> :C. ('4 -<- '152 / o <br /> AIVAL DP ,ry17CTI�FIRE lx RINS O DATE IO <br /> ECTION 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 PagP-AUv MP 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 1 .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 /> CONLMENTS (Items marked "NO" above must be explained in this section) <br /> ���� ��rC t; /Y C � +'c� t- <'. '- �1� C r y' c-l<'i r Com•S <br /> r i <br /> REFERRALS (FOR OES USE ONLY) C SJ Ag []SJ Env Hlth [:]OSI':A [] 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 /> Business Representative(Print Name and Tit!c) Business Representative(Signature) <br /> Name of Inspector and Fire Company WHITE COPY: OEs <br /> • CANARY COPY: FIRE PREVENT CN REV 11/96 <br /> - l._ PINK COPY: BUSINESS <br /> T O d J tjMQtjg 82 = S T N'QWINT, <br />