Laserfiche WebLink
'r .ri• <br />COUNTY OF` SAN:'-.?PF <br />,M• <br />"`OFFICE OF EMERGENCY SERVICES <br />EA <br />.222' ST:-WEBEWAVENUE <br />d . �- <br />.. _ STO.CKTON, C!'•LIFORNIA_95202 <br />HONE` 209) 468-3969 <br />1 \T f -r, .. ',..i•ji;'-'>�. a^ 'K{ EIy_L '. -. (-... P .il.. VN hastib <br />'t HAZARDOUS''MATERIAI;S PROGRAM INSPECTION FORM <br />jFT FpHONE NUMBER; -i <br />BUSINESS NAME f : Qr-ter> <br />ZIP ODE <br />BUSINESS ADDRESS (Faci ty Be�sPected) <br />,� 1 DEPARTURE <br />TIME 1NSPECII <br />- IFINSPECTi ARRIVAL TIME �f. <br />4 ' FIRE DISTRICT- O /DA 'f):� 0:0 O <br />�( /C All fi„ , " �r.� •.+DI-4„..nrt <br />' :INSPECTION RESULTS -`:'.:.::.......: t <br />.. ._.,`•FACIL:TTY�WAL,K•Ti�tOUGH T'� ,:..-+YES'-NO- <br />�.DOCUM,:. • . •T REVIEW <br />'YES ' NO . <br />E`+ <br />7: _Facility Map.Complete;and'Accuraie ;• `. =; <br />1, Business Iil.II�'IP/Inventory OnSiteR <br />8:...Chemical'Inventory Complete'&Accurate S •`. �:'�: <br />? <br />: 2;' HMMP/Map Easily Accessible to Etnployees - 9.: ;Employes Familiar with HMMP <br />3. Bus ID Pagc/HMMP Complete and Accurate 10 plant Operations Appear Safe <br />4: If Business is a Hazardous Waste Generator; . <br />11. Materials 'Being Handled Y <br />s=, .are Hazardous Waste Manifests On Site t <br />d Labeled - <br />erly Stored an <br />:` _ • - '- is MSDS On Site - 12:.Materials Prop -•-• • L,: <br />S:.Material'Safety:Data Shee ( ) <br />13 Soil and Facility Appear Non Contaminated <br />6. Cu- nt,Training Records On Hand <br />F.., " above must be ezpiained:in this' section) > r z <br />C011?,'yiENTS (Items . marked NO �^ 9i !3R' c <br />n. a <br />/i -'.�!.- .1r*°„ '�'1• h u 3K -t t.. <br />t. <br />rA 'g,i � 0`•ry 1 �� Il 1 . t -ter..-:. }•.1 it. <br />' � rte• � - ,.,� < �-'•.•ri� <br />• •C9 f Lt'•A NS. <br />=t' 1Mov- c� �.... <br />:. •'. <br />Fire Air Dist''' r ' <br />' SJ A� - � SJ. Env Hith <br />L.J. osx�.: a <br />REFERRALS (FOR OES USE, ONLY) :. g .._,. -.... • r,::::o. tia c!-+ <br />- OES Inspector Name Performin& .0 clw , <br />IN PECTI N FOLLOW UP INFORMATION' <br />Corrective Actions 4tust Be Delivered To OES'By. Follow Up Inspection'Date :. ' i <br />RECEIPT OF INSPECTION RESULTS <br />ACKNOWLEDGEivIENT OF REVIEW AND Representative (S gnature).; <br />Till Business' <br />en (Print Name and e), fr �;� <br />Business Repres tative J• r, 'J • ,..��',.'}�(� , i,' j �/ �t •.� <br />a I [►.l [1..C'� x� 1_ri , �' !�y ` WHIIECOPY: OES'• - ' '' •' 'x-'• ;,', <br />7 '(,i. ;•� 1 w i FIRE PREVENTION R. <br />N(_ ti CANARY COPY <br />am sFFDDector and Firp CompandyR, 4; p BUSINESS' <br />