Laserfiche WebLink
Pqutp <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> :< IjOOM 610, COURTHOUSE <br /> 2 2 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> �' •• �;:� BUS.(209)468-3969 FAX(209)944-9015 <br /> 1�iFd.R <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> U f t/t Grohs Q3e--,�ry 9'W -077 <br /> 62, <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIpPC�O—DE <br /> 12d-5-1J <br /> / i of-24 l <br /> FIREDI TRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> opt 10 a -0&- O93 7 <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1. Business HMMP/Inventory On Site tii' 7. Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees v/ 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 11.Materials Being Properly Handled <br /> 5.Material Safety Data Sheets (MSDS)On Site ✓ 12.Materials Properly Stored and Labeled <br /> d �-- <br /> 6.Current Training Records On Hand 13. Soil and Facility Appear Non-Contaminate <br /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> REFERRALS (FOR OES USE ONLY) [:]SJ Ag [:]SJ Env Hlth E]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 /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> B 'ness Repr seen ativ (Print Namg and Title) Busi Represe at (S lure) <br /> l/ <br /> Nam of Inspector and ire Company ITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> OES-HM 1 (MXn <br />