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AL <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 91 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> - FAX(209)915 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Jahant Food N Fuel Stop, Inc 333-2972 <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> 24323 N. Hwy 99 <br /> FIRE DISTRICT INSPECTION DATE JARRIVAL TIME DEPARTURE TIME 1INSPECTIONTYPE <br /> Woodbr 1 /-7-,0-3 J/00 1 f//SHMMP <br /> — <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 Employees 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, 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site? 11.Hazardous Materials Being Properly Handled by Employees <br /> 5. Material Safety Data Sheets(MSDS) On Site 12.Hazardous Materials Properly Stored and Labeled <br /> -� 6.Current Training Records On Hand ill 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) <br /> I i 2 Co I trr aVadC4,171f Si . <br /> S Ins�S Nlo7 QUezalaAl . <br /> #��O No vhvh �a1PA3 a. � 'Jlti� at e� gt <br /> /- l7-03 <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <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) Business Representative(Signature <br /> Name of Inspector Agency Fire Co. (If Appropriate) WHITE COPY: O REV 9/02 <br /> Phillip Cook I PINK COPY: BUSINESS <br />