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COUNTY OF SAN JOAQUIN RECEIVED <br /> OFFICE OF EMERGENCY SERVICES NOV 28 MW <br /> ROOM 610,COURTHOUSE bAN JUAUUIN UUUN I Y <br /> 222 EAST WEBER AVENUE OFFICE OF EMERGENCY SERVICES <br /> STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Big K — Mart Store #4862 I 825-3033 <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> 255 Northgate Drive <br /> FIRE DISTRICT 24 INSPj I'ON E ART14L,TIME DEPITUREE T�E INSSPPEPCTION TYPE <br /> l! INSPECTIONRESULTS <br /> li & <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 0. Employees Familiar with HMMP <br /> 4.If Business is a Hazardous Waste Generator, 0.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 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explained in this section) <br /> t - Qo copyvr SMC S, d Te <br /> Vj0�0 pymS <br /> -- `W( 1 ff� :� <br /> kLL <br /> wo <br /> REFERRALS ❑SJ Ag ❑SJ Env HIth ❑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 RE <br /> u n ss Aep esen ti not Name a r - res ive{Signature) <br /> Name Spec Agency\ ,I �/� Fir ( f ropriate) WHl'CE COPY: OES <br /> PINK COPY: BUSINESSV 9/02 <br />