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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> lot 222 EAST WEBER AVENUE <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 /> Flying J Inc - 339-4066 <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> 15100 N. Thornton Rd <br /> FIRE DISTRICT T-Z <br /> SPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> Delta —(o -03 1 1U3I�l /13or HMMP <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO I 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 13. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) <br /> 2– <br /> f3— I IA77 ' F 1175 L°L'r-7�t <br /> 7 F3 tl-b b L' O ro rtt 07v - 0400% .2-/7-03 <br /> REFERRALS ❑SJ Ag ❑SJ Env 0th ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Delivered to nFc Ity 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 0 Fire Co. (If Appropriate) WHITE COPY: OES REV 9/02 <br /> Phillip Cook PINK COPY: BUSINESS <br />