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COUNTY OF SAN JOAQUIN <br /> �4�Q•�a OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> r. X222 EAST WEBER AVENU; <br /> STOCKTON, CALIFORNIA 95202 <br /> ��•• �.k;I�� TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NA.titE / �- TELEPHONE NUNMER <br /> 7t Cf 14 .r". f, -t -/;,7—- <br /> BUSINESS ADDRESS (Facili YBein`gTms d) CODE <br /> rREr DC ARRIVAL TINE DE/' TdURLESO <br /> N TYPE <br /> jS'o Cjib i t <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 S. Chemical Inventory Complete&Accurate <br /> 3.Bus ID Page/HNEIAP 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 Nan-Contaminated <br /> CONLMENTS (Items marked "NO" above must be explained in this section) <br /> A'C, i l: •t; r C •'c �S G ^, f <br /> 4'.:"It1 �. :� •i. F✓, J (;r"' J �i�il9.e / ">/. ! l•'✓G . �% 'ci� ar_ r� <br /> REFERRALS (FOR OES USE ONLY) []SJ Ag [:]SJ Env Hith []OSHA [] Fire [] Air Dist <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must Be Delivered To OFS 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 RepresentAdye(Signature) <br /> Name of Ins pec or.and Fire Company WhtITE COPY: OES <br /> t / ', CANARY COPY: FIRE PREVENTION RIV 11/% <br /> 6 ._i ✓ •. <br /> 1..!1 . ✓. I PINK COPY: BUSINESS <br /> t(t4M p' <br /> T 0 <br /> d <br /> � HMQHS 8S = S T N WT <br />