Laserfiche WebLink
r-1 <br />i1 <br />�...y COUNTY OF SAN JOAQUIN <br />a°�Q•�o� OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />a: :e 222 EAST WEBER AVENUE <br />STOCKTON, CALIFORNIA 95202 <br />TELEPHONE (209) 468-3969 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME <br />/ EL / -Co Fa7Z)s <br />TELEPHONE NUMBER <br />BUSIaN,E,S//S� ADvS ESS (Facility Being Inspected) <br />Z3'1Sa /„19&G11l% (!/iec� <br />ZIP CODE <br />7�-250 <br />FIRE DISTRICT' <br />INSPECnON DATE <br />ARMAL T1ME <br />09sv <br />DEPARTURE TIME <br />jUiv <br />I INS EC-n0N TYPE <br />/�2�i�7Csa.7on/ <br />INSPECTION RESULTS <br />DOCUMENTREVIEW 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 />3. Bus ID Page/HMMP Completeccurate <br />9. Employees Familiar with HMMP <br />4. If Business is a Hazard aste Generator, <br />are Hazardous a Manifests On Site <br />10. Plant Operations Appear <br />11. Materials B ' operly Handled <br />5. Mater' afety Data Sheets (MSDS) On Site <br />12.nals Properly Stored and Labeled <br />urrent 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 />SO I &s OF pVdZAM. /yid /ivS <br />�/F}lrl7tr UtZ iL L SA-iGi — ,Y— Ti L � T <br />GEr7�ST — — i 2 liv <br />REFERRALS (FOR OES USE ONLY) ❑SJ Ag SJ Env Hlth OOSHA [jFire ❑ 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 />ACKNO GFMtNT jQF REVIEW AND PEV.YIPT OF INSPECTION RESULTS <br />Busine pr v <br />Business Representative (Signature) <br />N e of h4etfor re Com <br />WHITE COPY: OES <br />CANARY COPY: FIRE PREVENTION <br />PINK COPY: BUSINESS <br />REV 11/96 <br />OES HM1(11M) <br />