Laserfiche WebLink
COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> • 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 /> BUSINESS NAME TELEPHONE NUMBER <br /> L14C L1e;, - We f( <br /> BUSINESS ADDRESS (Facility Being Inspected) n <br /> Lk l rt a <br /> FIRE DISTRICT INSP CTION DATE ARRIVAL TIME DEPARTURE TIME 1INSPECTIONTYPE <br /> 1 • [a-riz'f 1 19.1 ltWl `x <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1.Business HMMP/Inventory On Site Il 7.Facility Map Complete and Accurate $' <br /> 2.HMMP/Map Easily Accessible to Employee 8.Chemical Inventory Complete and Accurate <br /> 3.Bus ID PagedRAMP 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. 1.Hazardous Materials Being Properly Handled by Employee. <br /> 5.Material Safety Data Sheets(MSDS) On Site 12.Hazardous Materials Properly Stored and Labeled <br /> 6.Current Training Records On Hand 113.Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explained in this section) <br /> • <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <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) Business Re sent (Signature) <br /> 10 c.O M1I <br /> Name of Inspector Agency Fire Co. Appropriate) WHITE COPY: OES REV 9/0 <br /> PINKCOPY: BUSINESS <br />