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ti� <br /> :COUNTY OF`SAN`'JOAQUZN' <br /> ' <br /> �a�t!tr• o 7, OFFICE OFMIvfERGENCY SERVICES <br /> ���v •.o •ROOM610,..COURTHOUSE' .** µ, <br /> ...:'r,,.. '•i <br /> a < 222'EAST:WEBER'AVENUE <br /> STOCI{TON,CAI:¢ORNIA.95202 :j Y T}•:, �' ��. <br /> HONE 209)468-3969: [ Y; F ,MF�M:7�.T <br /> HAZARDOUS MATERIAL'S PROGRAM INSPECTION 'FORMTFI FpHONENUMBI�t'^ <br /> FB NAMrE . Y <br /> cel -/<•�.. <br /> �S ADDRESS(Pati ty Be inspected) l L/ .�- ` =g ' s "`` . Y n¢ rINSp DA pRRiVALTIME DEPARNRE 17M ' � / ,/ ti y,TRICT INSPECII ,+�,:oc _ iT <br /> ' :INSPECTION RESULTS .r All NO <br /> .'. <br /> YES <br /> .- ;NO <br /> REV ":FACII:ITY W;�;K•TIBZOUGH <br /> :DOCUME`+T REVIEW ..• and'Accuraie- <br /> - 7,_FacilityMap.Complet6' <br /> vento On Site _ F <br /> 1:Business HMMP/In rY <br /> 8:.;.Chemical'Inventory Complete'&-Accurate _ l' <br /> - • - ' - Y Ti ray l'C j1 •�131_ <br /> 2:'HMNIP/Map Easily Accessible to Employees 9• .Employees Familiar with HMMP". '' <br /> f 3:Bus ID Page/HMMP Complete and Accurate 10.Pians Operations Appear Safe <br /> - <br /> 4.If Business is a Hazardous Waste Generator; <br /> 11.Materials'Being Properly Handled <br /> :.are Hazardous:Waste Manifests On Site <br /> 12. properly Properly Stored and Labeled::•„ :. [n. �j <br /> t'- - Data Sheets (MSDS)On Site • -r�•- <br /> 5:.Materiaf Safety. ear Non-Contaminated;:. <br /> 13.Soil and Facility App <br /> t' 6.Current Training Records On Hand <br /> - �` \ r <br /> COMMENTS (Items.marked '"NO". above must be explained in this* section) ,L' 7: <br /> .t' <br /> r+^<- <br /> F'�YTK `,11,•' Ir v +P..'• � � ' q'F'° .�( !r '-�11xZ Ya�"^�' _ <br /> y + <br /> t) r • W <br /> , <br /> !.. j / (/ � lit � .`-r Zl�i,.J��•. <br /> :L r},+' <br /> I Z <br /> Cr <br /> L- <br /> OSHA: � Fire ' 0 Air Dist <br /> FOR OES USE ONLY) E]S7'•Ag a SI.Env-Hlth _ _. ;:::o.,.tic•�!-s+�1' <br /> REFERRALS ( , .•. Follow;: <br /> FOLLOW UP INFORMATION•- OES Inspector Name Performing.,,.... <br /> IN PECTION `X•,`" <br /> Corrective Actions ivtust Be Delivered To ESBy T911OW lip Inspection Date , ' <br /> nature) <br /> ACKNOWLEDGE OF REVIEW ArD RECEIPT OF INSPECTION ess Repres ntative(S'g <br /> e and-Tide) ! r <br /> Business Representative(Print Nam r., ,r F r t •.!t"% "� �: <br /> MWHI'IECOPY: OBS, <br /> �. •._� _ .4 CANARY COPY:'FIREPREVFNI70N RS• <br /> c,vi';;ns ector end FiCompanyp,:. " '' , p -BUSINBSS , <br /> * Nam r sr .s- <br />