Laserfiche WebLink
COUNTY OF SAN JOAQUIN �. IV�D <br /> OFFICE OF EMERGENCY SERVICES I �' t" <br /> ROOM 610,COURTHOUSE MAY 172004 <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 5/UaramAmuo,aGIDUNIY <br /> ., �F o N*r • HAZARDOUS MATERIALS DIVISION(209)468-3969 F3CEOFMAIERCENCYSERVICE <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUM ER <br /> 4,!m <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> 1121" DajVff;;j <br /> FIRE DISTRICT INSP CTIp N DATE rIVAL TIME DEPARTURE TIME 1INSPECTIONTYPE <br /> 131 O,3t' HAwr <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMME/Inventory On Site V, 1 17.Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees V 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 I/ <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 /> V <br /> r <br /> REFERRALS ❑SJ Ag ❑SJ Env Nth ❑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 /> Bu ess Re resentative rint Name and Title) <br /> rs es true nat <br /> t t C t.4 <br /> of Inspe or C Agency r opnate) WH COPY: OS&L IPS <br /> PINK COPY: BUSINESS R /0 <br />