Laserfiche WebLink
a�tti COUNTY OF SAN JOAQUIN i <br /> OFFICE OF EMERGENCY SERVICES J �c/l/ 49 <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> •' STOCKTON,CALIFORNIA 95202 <br /> �q't/FO...... TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> //// s S.-ac.-731V sr 752410 <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TMIE I INSPECTION TYPE <br /> L00 //-9- uo 1350 / AMP7177 <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1. Business HMMP/Inventory On Site 7. Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees 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 /> are Hazardous Waste Manifests On Site /VI 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 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> f3 Nab M APO6Zeln 49LO-frQ6 <br /> /Z.UO 1144 A( <br /> AV <br /> AIM aA3ee <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 /> //- 20-Gv <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> S,ri4aG61ti S <br /> Name of Inspector and Fire Company WHrM COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> COOK PINK COPY: BUSINESS <br /> OES-HM1(1IM) <br />