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COUNTY OF SAN JOAQUIN <br /> aPQurk c OFFICE OF EMERGENCY SERVICES '� �� <br /> Q- y� ROOM 610, COURTHOUSE D E C 2 4 2C01 <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 .:C "l���lY <br /> BUS. (209)468-3969 FAX (209)944-9015 l}fFICEOFEE�'EtC� CYStI*iVICES <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME :1 TELEPHONE NUMBER <br /> Orchard Supply Hardware :i 239-2161 <br /> BUSINESS ADDRESS(Facility Being Inspected) ; ZIPCODE <br /> 189 W. Louise Avenue J 95336 <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> 24 �2—� Z � 14AA�P <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 Employees <br /> I-" <br /> 8. Chemical Inventory Complete&;Accurate <br /> I <br /> 3.Bus ID Page/HMMP Complete and Accurate / 9. Employees Familiar with HMMP / <br /> 10. Plant Operations Appear Safe <br /> 4.If Business is a Hazardous Waste Generator, / <br /> are Hazardous Waste Manifests On Site / 11.Materials Being Properly Handled <br /> 5. Material Safety Data Sheets(MSDS) On Site / 12.Materials Properly Stored and I-teled / <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 /> Wzt6 AVASLA BY 6W, F19W 116 <br /> y <br /> A <br /> _ L <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag ❑SJ Env Hlth [-]OSHA [] Fit,- []AFir Dist <br /> INSPECTION FOLLOW UP INFORMATION lM <br /> Corrective Actions Must Be Delivered To OES By Follow Up Inspection Date OES Inspect6r Name Performing Follow Up <br /> .F <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representati a(Print Name and Title) Busin sent � t <br /> Lt/22 t-W15T'�Od►1 Pr 1M <br /> Name of Inspector and Fire Company WHITE Y: OES <br /> CANARYCOPY: FIRE PREVENTION REV I Il96 <br /> PINK COPY: BUSINESS <br /> -' OES-HM 1 (9/00) <br /> 3� <br />