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COUNTY OF SAN JOAQUIN <br /> �4, Q•�o OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> X222 EAST WEBER AVENU9 <br /> •'• STOCKTON,CALIFORNIA 95202 <br /> TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NA%1E �. NE ER <br /> �,_ - (_ -/-I <br /> BUSINESS ADDRESS(Facilit�$eing"Tnsed) CODE <br /> PFC 75.2 /O <br /> FIRE ro <br /> / INS O DATE l A uR,W TUAE DEP TURF,4TME ,S79 / <br /> ECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACa=WALK THROUGH YES NO <br /> I.Business HMMP/Invcntory 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 PageAU 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(MS DS)On Site 12.Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 13.Soil and Facility Appear Non-Contaminated <br /> CONLMENT'S (Items marked "NO" above must be explained in this section) <br /> 7 IJ r t t; cel, NF1 �• i <br /> its, c C e -f <br /> 4e✓, 7 r%c� 1 Ii•j li�R i/ '>I. I Lc�C : / -�i� F t <'� <br /> REFERRALS (FOR OES USE ONLY) SJ Ag SJ Env Hlth []OSHA � Fire �Air Dist <br /> INSPECTION FOLLOW LP 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 Title) Business Representative(Signature) <br /> Name of Ins or.an I Fire Company <br /> WHITE COPY OES <br /> / ` .. �, CANARY COPY: FIRE PREVENi10N REV 11/96 <br /> G�� - r �.. I .: PINK COPY: BUSINESS <br /> 71 Uloff".1. <br /> T 0 1 d M Q d S 8 £ = S T fJ��W ': t <br /> i <br />