Laserfiche WebLink
A, N COUNTY OF SAN JOAQUIN <br /> e°• a'•�c OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> rig 222 EASTWEBER AVENUE <br /> •`• STOCKTON,CALIFORNIA 95202 <br /> �ytikcR`'�' TELEPHONE(209)468-3969 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS NAME TELEPHONE NUMBER <br /> /� 368-7912 <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 2 z - 9s <br /> FIRE DISTRICT INSP ON DATE ARRIVAL TBvffi DEPARTURE TIIv1E INSPECTION TYPE <br /> &' //3v <br /> INSP ON RESULTS <br /> DOCUMENT REVIEW NO FACILITY WALK THROUGH YES NO <br /> 1. Business HMMP/Inventory On Site 7. Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Acces to Employees S. Chemical Inventory Complete&Accurate <br /> 3.Bus ID Page/HMMomplete and Accurate 9. Employees Familiar with HMMP <br /> 1p_4.If Business azardous Waste Generator, 10.Plant Operations Appearis <br /> are Hazodus Waste Manifests On Site 11.Materials BeinPprly Handled <br /> 5.MajAl Safety Data Sheets(MSDS)On Site 12.Materi ZRoperly Stored and Labeled <br /> 6.Current Training Records On Hand 113,,Siand Facility Appear Non-Contaminated <br /> COMMENTS (Items marked "NO" above must be explai ed in this section) <br /> gi <br /> _Ej <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag SJ Env Hlth []OSHA Fire Air Dist <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Myst Be D ivered To OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> ACKNOWL OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Represe tative(Print Name and Title) Business R e(Signature <br /> G Y' <br /> am ect an <br /> any CA FIR COPY: <br /> CANARY COPY: PURE PREVENTION REV 11/96 <br /> PINK COPY: BUSINESS <br /> OES XM 1(11I ) <br />