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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> l0 Ei ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> 70 `t HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME - TELEPHONE NUMBER <br /> rn ail ✓ �5-�-�7o <br /> BUSINESS ADDRESS(Facility eing Inspected) <br /> 710e A , ` Q 4v <br /> FIRE DISTRICT INSPECTION DATE JAIIRIVALTIME DEPARTURE TIME INSPECTION TYPE <br /> Matt e ea -U7 Uhf T U 1, <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site A7.Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees 18.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/HMMP Complete and Accurate 19. 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 Employee <br /> 5. Material Safety Data Sheets (MSDS) On Site 112.Hazardous Materials Properly Stored and Labeled <br /> 4- <br /> 6. Current Training Records On Hand 113. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) <br /> \Aj OL <br /> e,,v- GVvAQr 5LAce <br /> Lc� U 6L451 1 fa 47 <br /> W11 ✓' It 1/L <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 Repr entative(Print Name and Title) Busininct_ <br /> esentative/�Signature) <br /> A U I � (S '4 i2Z � <br /> Name of Inspector = Agency Fire Co.(If Appropriate) WHITE COPY: OES <br /> La1/( 5 PINK COPY: BUSINESS I REV 9/02 <br />