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' r .ri• <br /> COUNTY OF` SAN:'-.?PF <br /> ,M• <br /> "` OFFICE OF EMERGENCY SERVICES <br /> EA <br /> .222' ST:-WEBEWAVENUE <br /> d. �- <br /> .. _ STO.CKTON,C!'•LIFORNIA_95202 <br /> HONE` 209)468-3969 <br /> 1 \T f-r,..',..i•ji;'- '>�.a^ 'K{ EIy_L '. -. (-... P .�1.. VN hastib <br /> 't HAZARDOUS''MATERIAI;S PROGRAM INSPECTION FORM <br /> �T FpHONE NUMBER;-i <br /> BUSINESS NAME f : Qr- ter> <br /> ZIP ODE <br /> BUSINESS ADDRESS (Faci ty Be �sPected) <br /> ,� l DEPARTURE <br /> TIME 1NSPECII <br /> -IFINSPECTi ARRIVAL TIME � f . <br /> 4' FIRE DISTRICT- O /DA 'f):� 0:0 O <br /> �( /C All fi„ , " �r.� •.+DI-4„..nrt <br /> ' :INSPECTION RESULTS -`:'.:.::.. .....: t <br /> . . ._ .,`•FACIL:TTY�WAL,K•THItOUGH T'� ,:..-+YES' -NO- <br /> �.DOCUM,:.• . •T REVIEW <br /> ' YES 'NO . <br /> E`+ <br /> 7:_Facility Map.Complete;and'Accuraie;•`.=; <br /> 1,Business Iil.II�'IP/Inventory OnSiteR <br /> 8:...Chemical'Inventory Complete'&Accurate S•`. �:'�: <br /> ? <br /> : 2;'HMMP/Map Easily Accessible to Etnployees - 9.:;Employes Familiar with HMMP <br /> 3.Bus ID Pagc/HMMP Complete and Accurate 10 plant Operations Appear Safe <br /> 4:If Business is a Hazardous Waste Generator;. <br /> 11.Materials'Being Handled Y <br /> s=, .are Hazardous Waste Manifests On Site t <br /> d Labeled- <br /> erly Stored an <br /> :` _ •- '- is MSDS On Site - 12:.Materials Prop -•-• • L,: <br /> S:.Material'Safety:Data Shee ( ) <br /> 13 Soil and Facility Appear Non Contaminated <br /> 6.Cu- nt,Training Records On Hand <br /> F.., " above must be ezpiained: in this' section) > r z <br /> C011?,'yiENTS (Items .marked NO �^9i !3R' c <br /> n. a <br /> n -'.� !.- .1r*°„ '�'1• h u 3K-t t.. <br /> t. <br /> rA 'g,i �0`•ry 1 � � Il 1 .t-ter..-:.}•.1 it. <br /> ' � rte• � - ,.,� < �-'•.•ri� <br /> • •C9 f Lt'•A NS. <br /> =t' 1Mov- c� �. ... <br /> :. •'. <br /> Fire Air Dist''' r ' <br /> ' SJ A� - �SJ.Env Hith <br /> L.J. osx�.: a <br /> REFERRALS (FOR OES USE,ONLY) :. g . ._,. -.... • r,::::o. tia c!-+ <br /> - OES Inspector Name Performin& .0 clw, <br /> IN PECTI N FOLLOW UP INFORMATION' <br /> Corrective Actions 4tust Be Delivered To OES'By. Follow Up Inspection'Date : . ' i <br /> RECEIPT OF INSPECTION RESULTS <br /> ACKNOWLEDGEivIENT OF REVIEW AND Representative(S gnature).; <br /> Till Business ' <br /> en (Print Name and e), fr �;� <br /> Business Repres tative J• r, 'J • ,..��',.'}�(�, i,' j�/�t •.� <br /> a I [►.l [1..C'� x�1_ri , �' !�y ` WHIIECOPY: OES'• - ' '' •' 'x-'• ;,', <br /> 7 '(,i. ;•� 1 w i FIRE PREVENTION R . <br /> N (_ ti CANARY COPY <br /> am sFFDDector and Firp CompandyR, 4; p BUSINESS' <br />