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Ah <br />Ah <br />1W 7 <br />COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE <br />A STOCKTON, CALIFORNIA 95202 <br />L HAZARDOUS MATERIALS DIVISION (209) 468-3969 <br />FAX (209) 944-9015 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME <br />Ameri as Propane <br />TELEPHONE NUMBER <br />BUSINESS ADDRESS (Facility Being Inspected) <br />22920 N Hwy 99 East Frontage Rd <br />FIRE DISTRICT <br />Woodbridge <br />INSPECTION DATE <br />/ -O 3 <br />JARRIVAL TIME <br />1/2,$ <br />DEPARTURE TIME <br />//35 <br />INSPECTION TYPE <br />HMMP <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br />1. Business HMMP/Inventory On Site <br />7. Facility Map Complete and Accurate <br />2. HMMP/Map Easily Accessible to Employees <br />8. Chemical Inventory Complete and Accurate <br />3. Bus ID Page/I-IMMP Complete and Accurate <br />67 9. Employees Familiar with HMMP <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site? <br />N�10. Plant Operations Appear Safe <br />11. Hazardous Materials Being Properly Handled by Employees <br />5. Material Safety Data Sheets (MSDS) On Site <br />12. Hazardous Materials Properly Stored and Labeled <br />6. Current Training Records On Hand <br />13. Soil and Facility Appear Non -Contaminated <br />COMMENTS (Items marked "NO" above must be explained in this section) <br />D T Tim — A7 c-,-7 <br />REFERRALS ❑ SJ Ag ❑ SJ Env Hlth ❑ OSHA ❑ Fire ❑ DA ❑ <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective AP ' nc Must be Delivered to (?ES By <br />Follow Up Inspection Date <br />OES Inspector Name Performing Follow Up <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative (Print Name and Title) i at re) <br />wA� <br />Name of Inspect6r Agency Fire Co. (If Ap riate) <br />Phillip Cook <br />WHITE COPY: OBS <br />PINK COPY: BUSINESS <br />REV 9/02 <br />