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o�Qy,N c COUNTY OF SAN JOAQUIN <br /> a•'�ca',oG OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> ��Yipo'a'���• TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSIN&SS NAME TELEPHONE NUMBER <br /> Canc 1�0y6 ' <br /> BUSINESS ADDRESS(Facility Being In pected) ZIP CODE <br /> A <br /> s's o a�! . ;4 / 1' _, G 9.5-Z-0 6 <br /> FIRE D\ISTRICTL INSP _ �OJ1N VATE ARRIVAL TIME DEPARTu"i tmE INSPECTIONTYPE <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1. Business HMMP/Inventory On Site v 1 7. Facility Map Complete and Accurate I/ <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 On Site 11.Materials Being Properly Handled <br /> 5.Material Safety Data Sheets (MSDS) On Site ;1012.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 /> " li4ut Je,-07/ t <br /> 71 <br /> 7 26 9 <br /> # 7 - <br /> - <br /> - /� <br /> a n <br /> 0"e-ogev- <br /> 9.P Ll ir ✓u <br /> C t Q <br /> eae <br /> i <br /> t <br /> REFERRALS (FOR OES USE ONLY) SJ Ag []SJ Env Hlth []OSHA Fire Air Dist Ej <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) B = ss resenta ' 'gnature) <br /> 789 15-HS <br /> Name of Inspector and Fire Company WHITE COPY: OEs <br /> CANARY COPY: FIRE PREVENTION REV 11196 <br /> PINK COPY: BUSINESS <br /> OES-HM1(11M) <br />