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COUNTY OF SAN JOAQUIN`1 <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> #1 FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> \\o T_- . 'Cv�ri��- �s P�D wok , Cw• <br /> FIRE DISTRICT INSPE ION DATE ARRIVAL TIME IDEPARTURETRvIE 1INSPECTIONTYPE <br /> � <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1.Business HMMP/Inventory On Site J, 7.Facility Map Complete and Accurate <br /> 2.HMW/Map Easily Accessible to Employees 8.Chemical Inventory Complete and Accurate / <br /> 3.Bus ID Page/H [M[P 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? 11.Hazardous Materials Being Properly Handled by Employ ✓ <br /> 5.Material Safety Data Sheets (MSDS) On Site j 12.Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand ✓ 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) <br /> S\�' -._ C uQSI? ES3 . N,�R ` `�-'Se PcJI�•v�,Fs?3, . <br /> � e <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP 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 /> l�iF `r <br /> Gcl=✓_;�qrv." CccN %-.�.7� ;�i----i-,_ <br /> ame o Igspecto Agenccyy� 7 Fire Co.(If Appropriate) WHITE COPY: OES <br /> - tom+ \� t�t1eCw^N�'cwtC'�y. �,{. ,_�-1 F\ . PINK COPY: BUSINESS REV 910 <br />