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A COUNTY OF SAN JOAQUIN .. !C??_' 0M. VED <br /> ulN <br /> s� Qo OFFICE OF EMERGENCY SERVICES <br /> y < ROOM 610, COURTHOUSE DEC -9 2002 <br /> 222 EAST WEBER AVENUE <br /> r `F" STOCKTON, CALIFORNIA 95202i SEy <br /> TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Costa's Machine 823-0781 <br /> BUSINESS ADDRESS (Facility Being Inspected) ZIP CODE <br /> 272 Button Avenue, Manteca, CA 95336 <br /> FIRE DISTRICT WSPECCION DATE ARRIVAL TIME DEPARTURE TIME I INSPECITON TYPE <br /> 241 - J -0 -L 333 L/ut) HMMP <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1,Business HMMP/Invemory On Site 7. Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees 8. Chemical Inventory Complete&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 C Site N/ 11.Materials Being Properly Handled <br /> 5.Material Safety Data Sheets (MSDS)On Site 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 /> b vCuhe iu.� v <br /> 14/`l h !� <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag []SJ Env Hlth ❑OSHA Fire Air Dist <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must Be Delivered To OES By Follow Up Inspection Date DES 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 /> Name of Ins ctor and Fire Company WHITE COPY: OEs <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> OES HM1(11188) <br />