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ti� <br />:COUNTY OF`SAN`'JOAQUZN' <br />' <br />�a�t!tr• o 7, OFFICE OFMIvfERGENCY SERVICES <br />���v •.o •ROOM610,..COURTHOUSE'.** µ, <br />...:'r,,.. '• i <br />a < 222'EAST:WEBER'AVENUE <br />STOCI{TON, CAI:¢ORNIA .95202 : j Y T} •:,� ' ��. <br />HONE 209) 468-3969: [ Y;F, MF�M:7 �.T <br />HAZARDOUS MATERIAL'S PROGRAM INSPECTION ' FORMTFI FpHONENUMBI�t'^ <br />FB NAMrE . Y <br />cel -/<•�.. <br />� S ADDRESS (Pati ty Be inspected) L/. �- ` =g's"` ` .Y n¢rINSp DA pRRiVALTIME DEPARNRE 17M' �/ ,/ ti y, TRICT INSPECII ,+�, :oc_ iT <br />All : ..' '. i : � , r.::c;,•vFJ>�`�" <br />' :INSPECTION RESULTS .r NO <br />.'. <br />YES <br />.-;NO <br />REV ":FACII:ITY W;�;K•TIBZOUGH <br />:DOCUME`+T REVIEW ..• and'Accuraie- <br />- 7, _FacilityMap.Complet6' <br />vento On Site _ F <br />1: Business HMMP/In rY <br />8:.;.Chemical'Inventory Complete'&-Accurate _ l' <br />- • - ' - Y Ti ray l'C j1•11�131_ <br />2:' HMNIP/Map Easily Accessible to Employees 9• . Employees Familiar with HMMP". '' <br />f 3: Bus ID Page/HMMP Complete and Accurate 10. Pians Operations Appear Safe <br />- <br />4. If Business is a Hazardous Waste Generator; <br />11. Materials'Being Properly Handled <br />:.are Hazardous: Waste Manifests On Site <br />12. properly Properly Stored and Labeled:: •„ :. [ n.�j <br />t'- - Data Sheets (MSDS) On Site • -r�•- <br />5:.Materiaf Safety. ear Non-Contaminated;:. <br />13. Soil and Facility App <br />t ' 6. Current Training Records On Hand <br />- �` \ r <br />COMMENTS (Items .marked '"NO". above must be explained in this* section) , L' 7: <br />.t' <br />r+^<- <br />F'�YTK `,11,•' tw v +P..'• � t ' q'F'° .�( !r '-�11xZ Ya�"^�' _ <br />y + <br />j' Y) r iJ •,• 16^ <br />•••%...1 "!r"4• 1 `ri h"�.•4 •• <br />, <br />:L r},+' <br />I Z <br />Cr <br />L- <br />OSHA: � Fire ' 0 Air Dist <br />FOR OES USE ONLY) E] S7'•Ag a SI. Env-Hlth _ _ . ;:::o.,.tic•�!-s +�1' <br />REFERRALS ( , .•. Follow;: <br />FOLLOW UP INFORMATION• - OES Inspector Name Performing.,,.... <br />IN PECTION `X•,`" <br />Corrective Actions ivtust Be Delivered To ESBy T911OW lip Inspection Date , ' <br />nature) <br />ACKNOWLEDGE OF REVIEW ArD RECEIPT OF INSPECTION ess Repres ntative (S'g <br />e and-Tide) ! r <br />Business Representative (Print Nam r., , r l F r t •.! t" % "� �: <br />MWHI'IECOPY: OBS, <br />�. •._� _ .4 CANARY COPY:'FIREPREVFNI70N RS• <br />c,vi';;ns ector end FiCompanyp,:." '' , p - BUSINBSS , <br />* Nam r sr .s- <br />