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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> r. .z ROOM 610, COURTHOUSE <br /> N. < 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> c4Llfiaa`'rP BUS. (209)468-3969 FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Morada Self Storage 931-3062 <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIPCODE <br /> 10220 N. Hwy 99 95212 <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIMEINSPECTION TYPE <br /> WArgrinn z,�A 5 ?, S HIS <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 L"- <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 1 I I.Materials Being Properly Handled ✓ <br /> 5. Material Safety Data Sheets(MSDS)On Site 1✓ 12.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 /> 44 l �Z &N 4 P tao ✓t Oi dY1 $1 TL'E��C)P_.,_ I_T,/17/14�^' — 1-7I?i 6' D/F <br /> t h bttez //1/S &Z" <br /> AID MSPS' ®n/ S/RE 94(S—I& 15 --W64S & r 15"SIDJ div s <br /> REFERRALS (FOR OES USE ONLY) []SJ Ag ❑SJ Env Hlth [:]OSHA Fire []Air Dist <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 /> &-22 fa/ <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Represe tive(Si <br /> gnature <br /> YlG�dlle� #,4,7f*/1 <br /> Name of Inspector and Fire Company WHITE COPY: OES <br /> Phillip Coale CANARY COPY: FIRE PREVENTION REV 11196 <br /> P PINK COPY: BUSINESS <br /> OES-HM 1 (9100) <br />