Laserfiche WebLink
COUNTY OF SAN JOAQUIN <br /> u OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME �J TELEPHONE NUMBER <br /> lll.f /� C ✓ <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> 2 oc e <br /> FIRE DISTRICT INSPECT ON DATE ARRIVAL TIME ]7TURE TIME INSPECT ON TYPE <br /> ��.T .' O <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site 1 17.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, 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 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 /> 1 G7lJF�P L� nC�'✓' � �. <br /> o P a Pn/ <br /> 7 i <br /> d f <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 RES <br /> Business Representative(Print Name anTi Title) Bu ' ss s tative(Signature) <br /> S �S <br /> Name of Inspecto Fie Appropriate) WHITE COPY: OES <br /> PINK COPY: BUSINESS I REV 9/02 <br />