Laserfiche WebLink
0 • <br />COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />2101 E. Earhart Avenue, Suite 300 <br />Stockton, California 95206 <br />Telephone: (209) 953-6200 <br />Fax: (209) 953-6268 <br />ipHAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME/ / t*_ _` <br />W Y Y 6 U I <br />A <br />DRESS (F <br />ility Being Inspected) <br />Ill <br />AC UNT # <br />a�Z <br />START DATE (New Bus) <br />INSPECTION DATE AR <br />l �o <br />IVAL TIME <br />7C11150p <br />DEPART IME INSPECTOR NAME <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. HMMP/Map On Hand and Easily Accessible ' <br />6. Facility Map Complete and Accurate <br />2. Business Identification Page Complete & Accurate <br />7. Presence of Non -Listed Regulated Chemicals <br />3. Business HMMP Complete and Accurate <br />8. Employees Familiar with HMMP <br />4. Chemical Description Pages Complete and Accurate <br />9. Hazardous Materials/Waste Properly Labelled <br />5. Training Records Available <br />10. Conditions that would hinder implementation of <br />Emergency Plan or increase risk of release are absent <br />EXPLANATION OF FINDINGS AND COMMENTS <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions <br />To Be Submitted By: <br />Additioytal <br />Referrdls/Notes: <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESUL <br />ustness Representati (Print Name and Title) Busing Rj1re e a' a (Signature) WMTE COPY: OES <br />IfVI,�\IOGi'A�Q.v(t PINK COPY: BUSINESS <br />REV 11/08 <br />J <br />