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PAU y <br /> COUNTY OF SAN JOAQUIN <br /> s4�soo OFFICE OF EMERGENCY SERVICES <br /> cZA ROOM 610,COURTHOUSE <br /> a: .. `.< 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> OME6t1 vl F <br /> BUSINESS ADDRESS(FacilityBeing Inspected) ZIP CODE <br /> 1!273 N ><//v SB 759YO <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME I INSPECTION TYPE <br /> Mok i - -Uo i3�e its- VEIL <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NP 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 Empl 8. Chemical Inventory Complete&Accurate <br /> 3.Bus ID Page/HMMP Com and Accurate 9. Employees Familiar with HMMP <br /> 4.If Business is a lipatfous Waste Generator, 10.Plant Operations Appear Safe <br /> are Hazard9prWaste Manifests On Site 11.Materials Being Properly H ed <br /> 5. Ma Safety Data Sheets(MSDS)On Site 12.Materials Properly Stowitrand.Labeled <br /> 6.Current Training Records On Hand 1 113. Soil and Facilit ppear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> A,bDZ4---TS IS AV 624nQAees<,vT <br /> T / <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag D SJ Env Hlth 0 OSHA Fire ❑Air Dist <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must Be Delivered To OES By Follow Up Inspection Date OES I for Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> Nate of Inspector and Fire Company WHITE COPY: OEs <br /> /L"/,o6w.,< CANARY COPY: FIRE PREVENTIONREV 11116 <br /> PMK COPY: BUSINESS <br />