Laserfiche WebLink
i <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> .! 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> t HAZARDOUS MATERIALS DIVISION (209)468-3969 <br /> 0 FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TETEPHON/E NUMBER <br /> 0. O <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> N <br /> FIRE DISTRICT INSPECTION DATE JARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <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, A 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site'? AIIA 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 /> L � <br /> 1799 <br /> � � / n w/i �ct� ia �orsoc4 <br /> ✓ /J4 dv` G „{r C.� /�bl+^+ j��L#Y/O/LJ n� �1tN c✓s [,.o <br /> b � /✓u-:re. z.'+- v,-- Co r est JL--, L✓Z PILO <br /> 7. avc. <br /> let <br /> �- a.�c g ✓E, DoT �1 c. :,� ui. hf�illLl <br /> Jif, <br /> "G s {<3 rl � ulu vs 0 <. . ._ e.v:� •C j-Ya ,X' <br /> REFER ALS ❑ SJ Ag ❑SJ Env Hlth ❑O A <br /> ® <br /> Z ❑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 /> Za. -<.r Z 2,010 <br /> ACKNOWLEDGENINT OP REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Bumess Repre entative(Print Name an tle) Business Representative(Signature) <br /> r inGO v t7C2i L <br /> Name of Inspector gency Fire Co. (If Appropriate) WHITE COPY: OES REV 9/02 <br /> /� �d /_!TPINK COPY: BUSINESS <br />