Laserfiche WebLink
COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />1iOy '' ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE <br />STOCKTON, CALIFORNIA 95202 <br />HAZARDOUS MATERIALS DIVISION (209) 468-3969 <br />— FAX (209) 944-9015 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BU NESS NAMETELEPHONE <br />NUMBER <br />BUSINESS ADD S Facility Being Inspected) <br />& �" ;!jt�%'064� C -,W 9� <br />FIRE DISTRICT <br />oclG � <br />INSPECTION DATE <br />j,-3-03 <br />JARRIVAL TIME <br />/� 0 ( <br />DEPARTURE TIME <br />// 3� <br />INSPECTION TYPE <br />AOVV12':p <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br />1. Business HMMP/Inventory On Site <br />7. Facility Map Complete and Accurate <br />2. HMMP/Map Easily Accessible to Employee <br />8. Chemical Inventory Complete and Accurate <br />3. Bus ID Page/HMMP Complete and Accurate <br />9. Employees Familiar with HMMP L <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site? <br />10. Plant Operations Appear Safe <br />11. Hazardous Materials Being Properly Handled by Employees <br />5. Material Safety Data Sheets (MSDS) On Sitel <br />12. Hazardous Materials Properly Stored and Labeled <br />6. Current Training Records On Hand <br />13. Soil and Facility Appear Non -Contaminated <br />COMMENTS (Items marked "NO" above must be explained in this section) <br />-K 9u S' <br />�fi � '""- �L/ !'l �Q'-f ✓Lf ^ �� =fJ / �J !S/ H � A� . / ��Qif��l G� <br />7Z -1t V <br />REFERRALS ❑ SJ Ag ❑ SJ Env 111th ❑ OSHA ❑ Fire ❑ DA ❑ <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions Must be Delivered to OES By <br />L�''13 —0-3 <br />Follow Up Inspection Date <br />OES Inspector Name Performing Follow Up <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Bu 'ness Representative (Print Name and Title) <br />�) 11 <br />B iness Representative (Signature) <br />Na,� ja of Inspector Agency n e Co. (If Appropriate) <br />., ' ai,^a ,�, �g�2 �/� <br />WHITE COPY: OES <br />PINK COPY: BUSINESS <br />REV 9/02 <br />