Laserfiche WebLink
Akk AK <br /> Ow COUNTY OF SAN JOAQUIN <br /> p0'4U(!V,..0 OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> r.� y <br /> m` < 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> BUS. (209)468-3969 FAX(209)944-9015 <br /> ,<IFOR <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> G/L✓/ G���' C� Circ z,,c 33 82t, <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> %9-'//V Al, R•Szzo <br /> FIREDISTRICT SPECTION DATE ARRIVAL TIME DEPART �IIv1E WSPECTION TYPE <br /> /705 S <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1. Business HMMP/Inventory On Site Y 7. Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees V_� 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 /> N <br /> are Hazardous Waste Manifests On Site l 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 i cl� 113. Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> -f'3 UPS &MoWr9T Tim- of 174 r& i <br /> S /MSDS A10,—, ,441C —4erus_0s mss AIM/ G'r/ r1ftF <br /> (o /Irrr rs�wl !r u <br /> 7 Oft �t /7 T T7s�ftT OF /N <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 Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> /-21-43 <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representatt a Prin ame and Title) Bust Representa' (Si re) <br /> :/a is <br /> Name of Inspector and Fire Company CA COPY: OES <br /> 'J/Gu CANARY COPY: FIRE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> OES-HM 1 (9100) <br />