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COUNTY OF SAN JOAQUIN <br /> 0.^4`'''t~• .c OFFICE OF EMERGENCY SERVICES <br /> e. � .o <br /> r.` = ROOM 610, COURTHOUSE <br /> r. + <br /> o, < 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> • -. BUS. (209)468-3969 FAX(209)944-9015 <br /> ��tFOM� <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> omega Vineyards <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 13731 N Hwy 88 95240 <br /> FIRE DISTRICT INSPECTION DATE ARRIVALTTIME DEPARTURE TIME I INSPECTION TYPE <br /> Mokeltimne —9 UZ 133 _ 1?yell <br /> INSPECTION 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 Em ees 8. Chemical Inventory Complete&A <br /> 3.Bus ID Page/HMMP Compl and Accurate 9. Employees Familiar with- P <br /> 4.If Business is a Haz5od6s Waste Generator, 10.Plant Operafions_.Apj<ar Safe <br /> are Hazardous>Afte Manifests On Site 11.Materials—<Properly Handled <br /> 5. Material ety Data Sheets (MSDS)On Site i12.M <br /> u t a als Properly Stored and Labeled <br /> 6.CTraining Records On Hand . Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be a ained in this section) <br /> _ ALO C,02,5i"7Z[�I?7)viiZ�7�/N_-� /$�•'� .�.zilJ �j�dr� _. <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag [_]SJ Env Hlth OSHA [:] Fire Air Dist <br /> INSPECTIONFOLLOW 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 /> Name of Inspector and Fire Company WHITE COPY: OES <br /> Phillip Cook CANARY COPY: FIRE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> OES-HMI (9)00) <br />