Laserfiche WebLink
PgUIN COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> ��tipb'piN�'• Fax:(209)953-6268 q <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS S fIAIvJFj ADDRESS(Facility,.Bee�ing Inspected S+ 10 <br /> o C— <br /> ACCOUNT# START DATE(New Bus) INSPEFTION DATE I ARRIVAL TIME IDEPARTURE TIME INSPECTOR NA E <br /> / V-32to1 ,3112-110 /Q O // 00 �2ol,1 cz <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals ✓ <br /> 3.Business HMMP Complete and Accurate L, 9. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available k 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> ►rOV 1 O�. I/ 1 Q Y l 0.v` 0.v�� 1 vv V Q Vt V 1-4 <br /> c' V1 W1 O � WaJ �e <br /> CL l0V'� ✓'LIA VK m Ljo tf o w t ee <br /> o � d i-wCD 0 - <br /> WOO. S 30 E S lNTA . 0ZG- <br /> (� AarN .' I 'fJZ (o <br /> � SS � ° ►�°� : GA 6 I 1 b 87 <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective ActionsAdditional <br /> To Be Submitted By: YO et.V -k 2-3/ 201 o Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Si nature) <br /> WHITE COPY: OFS <br /> M�� ) I �„ _ PINK COPY: BUSINESS <br /> h G -� REV IiJ <br />