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1 VMW <br /> 1� -- COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES FEB 2 3 2004 <br /> OOM EAST o, BER AVE FRCEOFEMERGENCYSERVICE <br /> 1 222 EAST WEBER AVENUE .- <br /> STOCKTON, CALIFORNIA�\ fF� _tI I <br /> ., ��� ��* • HAZARDOUS MATERIALS DIVISION 209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Keri {U&K Fri QO CICS LV_t4.1 � 12v 0 7012 <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> 22 v <e,kkl4t, MOfoJ LD GI 2u0 <br /> FIRE DISTRICT INSPECTION DATE JARRIVAL TIME DEPA4TURE TIME INS ECTION TYPE <br /> i Zo - i o ;H S : ()q 4 ► �P <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site 7.Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employee 8.Chemical Inventory Complete and Accurate <br /> 3. Bus ID Page/HMMP Complete and Accurate 9. Employees Familiar with HMMP <br /> 4.If Business is a Hazardous Waste Generator, N 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site? 11.Hazardous Materials Being Properly Handled by Employee <br /> 5. Material Safety Data Sheets (MSDS) On Site 12.Hazardous Materials Properly Stored and Labeled <br /> 6. Current Training Records On Hand 113. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) <br /> Of F\AfJ <br /> u r 4 4 b <br /> NQ-0-r) M5L 0 2 ad P; 0 x�o� <br /> r 0, S n r (44 b <br /> M AYc A M rvt- © epds 74 2 SO (�S <br /> fr^PIDJW,� 110 4Ki qr tN r4, 0 <br /> a C 1 n er- A +►l nod 6 Klo < < <br /> REFERRALS ❑SJ Ag ❑ SJ Env Mth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> CorrectiveAct ns Mus be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> Z <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESU <br /> Busi s Representative(Print Name and Tide) Busines presen tive(Signature) <br /> Name o nspector Agency Fire Co. (If Appropriate) WHITE COPY: OES <br /> Ofti PINK COPY: BUSINESS REV 9/0 <br />