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COUNTY . <br /> SAN. JOAQUIN <br /> ;1M• .. <br /> �4bMtf� co OFFICE OF'EMERGENCY SERVICES �� ��` " <br /> r, • yROOM 610, COURTHOUSE <br /> EAST:WEBERAVENUE ` <br /> - STO.CKTON,CAI:IEORNIA•.95202 <br /> t Vii• <br /> TELEPHONE`(209)468-3969 <br /> i • '• •• :•- .. •.. fir` __ .. .. ..... <br /> •y.� It{r• {• _ . <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> 'TELEPHONE NUM5. <br /> BUSINESS NAbIE j a1J �O S:► f <br /> t : <br /> DE <br /> Inspected) f _ y <br /> BUSINESS AnDDRESS(Faci ty Bei dIJ / .. I. . ,�[/��0- > > <br /> DEPARTURETIMEt 1NSPECI7 NW. <br /> FIR`E'D/IS RICT : INSPECIIO�DA ARRiVALTIME , <br /> � � IC:00 C' � YJ rpt Ci. i©rAb <br /> 7-n RESULTS �• 5�'� .N'' „ <br /> :..- <br /> - INSPECTION ••; .. •� ••� T1O, <br /> < " y NO= FACII:TTY WALK THROUGH <br /> DOCUMENT REVIEW <br /> ` 1.:Busmess HMMP/Inventory On Site r Facility Map-Complete;and'Accurate. :.> <br /> Chemical'Iiiventory Complete'&Accurate �� <br /> 2:HMMP/Map Easily Accessible to Employees _+ <br /> Complete and Accurate 9. Employees Familiar with`HMMPi T� x'fiw' <br /> 3:Bus M Page/HM Compl 10.Plant Operations Appear Safe <br /> 4:If Business is a Hazardous Waste Generator; <br /> 11.Materials Properly Handled <br /> 6 ::are Hazardous Waste Manifests On Site , <br /> H12.Materials Properly Stored and Labeled: <br /> S:.Material Safety:Data Sheets (MSDS)On Site w; <br /> Records On Hand 13 Soil and Facility Appear Non-Contaminated-"' x z1�r. <br /> 6.Current.Training - rh <br /> COMMENTS"(Items .marked ""NO„.above must'be explained in this section) <br /> F <br /> „y � <br /> T , i r a• <br /> t � Ili. O•'`' Fn: .a i. :Eoy.,flira�.�i: ..:z'. <br /> -. ­ 777777777Yd ..1 <br /> C. <br /> Fire Air Dist-77� <br /> REFERRALS (FOR OES USE,ONLY) a SJ•Ag: ❑SJ,Env Hlth a OSHA Y a ,„•,,yoxn 4 rtx,t ,; <br /> IN PECTI N FOLI;O�V UP INFORMATION' Follow,t <br /> • <br /> ' Corrective Actions Must Be Dclivered.To OES By Follow Up Inspection Date OES Inspector Name Performing;. <br /> w -.- <br /> ------------------ <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS aturc <br /> Business Representative(Print Name and Title), <br /> Business Representative(S gn ) „ <br /> ft/ <br /> HrIE OES <br /> COPY: <br /> ( l �, tty RE - <br /> Namc„oPltis ector nd Fir Company, CANARY COPY 'FIRE PREVENTION <br /> / f F e P -BUSINESS'' <br />