Laserfiche WebLink
COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> m ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> ` STOCKTON, CALIFORNIA 95202 <br /> {YiFoi�a`�• TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME / TELEPHONE NUMBER <br /> BUSINESSADDRESS (Facility Being Inspected o ZIP CODE <br /> S .� �sz i9 <br /> FIRE DIS CT INSPECT/ _DAq ARRIIVVALL TIME DEPARTUR/ETIME INNSP.P�_CTION TE <br /> f f 17 v /S t/CG <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES O FACILITY WALK THROUGH 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&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 /> 6.Current Training Records On Hand 13. Soil and Facility Appear Non-Contaminated <br /> CO'M'MENTS (Items marked "NO" above must be explained in this section) <br /> T00 _ <br /> Oil , <br /> Ct <br /> d / <br /> a i 9. l <br /> R '71-eBilia '� W44 o.r <br /> I�Qt ,Z i C .C- -Z' A J / .e G6. laof y <br /> REFERRALS (FOR OES USE ONLY) [:]SJ Ag [:]SJ Env Hlth OSHA [:] Fire Air Dist Lj <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 /> Business Representative(Print Name and Title) Bus e resentative(Signature) <br /> Name pector and Fire ompany WHITE COPY: OES <br /> CANARY COPY: FIRE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> OES-HM 1(11/%) <br />