Laserfiche WebLink
• • 7yY <br /> l�J <br /> COUNTY OF SAN JOAQUIN <br /> • OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> li STOCKTON, CALIFORNIA 95202 <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> L-2 t✓� a I'I V�Qi�/ <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> ±J:�_ <br /> FIRE DISTRICT 1INSPECTIONDATE rIVALTITVIE DEPARTURE T INSPECTION TYPE <br /> _G2 [�- <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION 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 and 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? 11.Hazardous Materials Being Properly Handled by Employees j <br /> 5. Material Safety Data Sheets (MSDS)On Site 12.Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 113.Soil and Facility Appear Non-Contaminated <br /> • COMMENTS(Items marked"NO"above must be explained in this section) <br /> dam+ L (C-vu t/ <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Delivered to OES ByFollow Up Inspection Date OES Inspector Name Performing Follow Up <br /> • ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name d Title) Business Representative(Signature) <br /> Name of Inspector -Agency Fire Co.(If Appropriate) WHITE COPY: <br /> PINK COPY: SHIMS REV 9/02 <br />