Laserfiche WebLink
fik <br /> Pquty COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> r. ? 2101 E. Earhart Avenue, Suite 300 <br /> v: <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> Fa :(209)953-6268 <br /> LIPCRN <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAMEADDRESS(Facility Being Inspected) <br /> �7 �✓/7/u0 oec��'2/ ?,313 <br /> ACCOUNT# START DATE(New Bus) INSPECTION ATE I ARRIVAL TIME DEPARTURE TIME JINSPECTOR.NAME <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> . <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate IX 7. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS � <br /> �S �S A.v cGA�irl cif <br /> r$rw/Gs4 Z' % �L1Gi1///// i.J /�� �w/y/a:�S c.�/fcli /D iw �,rr✓ <br /> �r�fiG2>G l�IS!/.�Ge� <br /> 6 77 C .�TlOnJ O /iv�ry �dr�S wi LG �6h� c�S <br /> INSPECTION FOLLOW UP INFORMATION <br /> o reclive Actions Additional <br /> Submitted By: ;71111) Referrals/Notes: .11/O/N6' <br /> AURNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usir�ss Repres tative(Print Na and T`[le) Busi ss Representative(Si nature) <br /> 1 ���r� I WHITE COPY: US <br /> ��Ihtl_.V I 11�_ <br /> PINK COPY: BUSINESS <br /> REV 12/08 <br /> 0 � - <br />