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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES DEC - q 2005 <br /> ROOM 610,COURTHOUSE bAN JUAUUIN COUNTY <br /> ' 222 EAST WEBER AVENUE CFFICE OF EMERGENCY SERVICES <br /> STOCKTON, CALIFORNIA 95202 <br /> � / .R V HAZARDOUS MATERIALS DIVISION (209)468-3969 <br /> -� FAX(209)9449015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Costa's Machine 823-0781 <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> 272 Button Avenue <br /> FIRE DISTRICT INSPECTION DATE JARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> 24 Z a g I1�), co HMKP <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site X 1 7. Facility Map Complete and Accurate <br /> 2.HMMP/Map Easily Accessible to Employee 8.Chemical Inventory Complete and Accurate <br /> 3. Bus ID Page/HMMP 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 Employee <br /> 5. Material Safety Data Sheets(MSDS) On Site 12.Hazardous Materials Properly Stored and Labeled <br /> 6. Current Training Records On Hand 113. Soil and Facility Appear Non-Contaminated X <br /> COMMENTS(Items marked"NO"above must be explained in this section) <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 Repre�ntative(Signature) <br /> j r� e u5 r4t /i//�u 9 ¢1 <br /> N e Inspe r Y A ency {Irk Fire (If Appropriate) WHITE COPY: OES <br /> , P-cw -.T: 2. PINK COPY: BUSINESS V 9/0 <br />