Laserfiche WebLink
Pc�,N COUNTY OF SAN JOAQUIN <br /> �4 •coo OFFICE OF EMERGENCY SERVICES <br /> a;. ROOM 610,COURTHOUSE <br /> m ` 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> C4�iFOPN`P BUS. (209)468-3969 FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS, SS NAME /p /� TELEPHONE NUMBER <br /> la-� L� /JR.f'7'C 'h -K 87 S4� -1177— 95X2— <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIPCODE <br /> 3S0 <br /> 7 y/ f�a ,fZ, Gam 9sap-i g <br /> FIREDISTRICT INS ION DATE ARRIVALTIME DEPARTURE TIME INSPECTIONTYPE <br /> S7<o�,e oh <br /> 101A101 o 3b <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH 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&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 N 11.Materials Being Properly Handled <br /> 5. Material Safety Data Sheets (MSDS)On Site ✓- 12.Materials Properly Stored and Labeled <br /> 6. Current Training Records On Hand l3.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> 1�a2,- copy <br /> 7, U <br /> I -Gtr-.`a'N !0 - �/ - •o l <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag []SJ Env Hlth E]OSHA [—] Fire ❑Air Dist <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 /> /d , /l -o/ /D - /I- a1 <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Repr entative(Signature) <br /> Name <br /> of�lInspector and ire Company WRITE COPY: OES <br /> /✓'*^uLf�9 ¢-' PINK COPY BUS NESS ELATION REV I I96 <br /> OES-HM1 (9/00) <br />