Laserfiche WebLink
OF SAN JOAQUIN <br />COUNTY <br />�qu!H OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />?� 222 EAST WEBER AVENUE <br />STOCKTON, CALIFORNIA 95202 <br />�. F • BUS. (209) 468-3969 FAX (209) 944-9015 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />TELEV,?— NU BERS <br />BUSINESS NAME <br />ZIP CODE <br />BUSINESS ADDRESS (Facilit Being Inspected) 9S2 -/S <br />FIRE DI TRICT I PE OND TE A ALTIM DEPARTO TIME WSPECTION TYPE <br />S���h <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP/Inventory On Site <br />✓ <br />7. Facility Map Complete and Accurate <br />8. Chemical Inventory Complete & Accurate <br />2. HMMP/Map Easily Accessible to Employees <br />9. Employees Familiar with HMMP <br />3. Bus ID Page/HMMP Complete and Accurate <br />LI <br />10. Plant Operations Appear Safe <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site <br />11. Materials Being Properly Handled <br />5. Material Safety Data Sheets (MSDS) On Site12. <br />0 <br />Materials Properly Stored and Labeled <br />6. Current Training Records On Hand <br />113. Soil and Facility Appear Non -Contaminated <br />COMMENTS (Items marked "NO" above must be explained in this section) <br />07 - Adot aAe-P _s O✓a- z 1v <br />r oJ ✓ l c i H a� Tif <br />42 e✓w� '. <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 RESULTS <br />Business Representative (Print Name and Title) <br />(5-/u lcV �G� m k to <br />B ' ess Represen t e Signature) <br />Name of Inspector and Fire CompanyWHITE <br />/! <br />COPY: OES <br />CANARY COPY: FIRE PREVENTION <br />PINKCOPY: BUSINESS <br />REV 11196 <br />GES-HM1 (9100) <br />