Laserfiche WebLink
r1 <br />COUNTY OF SAN JOAQUIN <br />O.p4u�N' C OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE <br />STOCKTON, CALIFORNIA 95202 <br />• c -., P BUS. (209) 468-3969 FAX (209) 944-9015 <br />,cikoa`' <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME 1 <br />r0 Cd T i 11 <br />TELEPHONE NUMBER <br />BUSINESS ADDRESS (Facility Being Inspected) <br />6 /9,7&aAr <br />ZIP CODE <br />9SZW <br />FIREDISTRICT <br />INSPEC/90NDA <br />ARRIVAL TIME <br />DEPARTURE TIME <br />IS' <br />INSPECTION TYPE/ <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP/Inventory On Site <br />7. Facility Map Complete and Accurate <br />2. HMMP/Map Easily Accessible to Employees <br />8. Chemical Inventory Complete & Accurate <br />9. Employees Familiar with HMMP <br />3. Bus ID Page/HMMP Complete and Accurate <br />10. Plant Operations Appear Safe <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site <br />I1. Materials Being Properly Handled <br />5. Material Safety Data Sheets (MSDS) On Site <br />12. Materials Properly Stored and Labeled <br />6. Current Training Records On Hand <br />13. Soil and Facility Appear Non -Contaminated <br />COMMENTS (Items marked "NO" above must be explained in this section) <br />!O� 1 .G Z,' <br />/%t/ <br />. <br />REFERRALS (FOR OES USE ONLY) ❑ SJ Ag ❑ SJ Env Hlth OSHA Fire Air Dist ❑ <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions Must Be Delivered To OES By <br />Follow Up Inspection Date <br />OES Inspector Name Performing Follow Up <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION <br />RESULTS <br />BuRepresentative (Print Name and Title) <br />J /a t IM rc, Aft- �LYf7'lU,o n'1 GZ S�JtR- <br />Business Representative igna <br />Company <br />Name of Inspector and Fire Company <br />/ <br />WHITE COPY: OES <br />COPY: FIRE PREVENTION <br />PINK COPY: BUSINESS <br />REV 11/96 <br />ucs - "m, tarw) <br />