Laserfiche WebLink
COUNTY OF SAN JOAQUIN <br /> o�. ........c <br /> a ' .oma OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON,CALIFORNIA 95202 <br /> O7�'jFORN�r• BUS. (209)468-3969 FAX(209)944-9015 <br /> BUSSNAME HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> -- TELEPHONENUMBER <br /> BUSINESS ADDRESS acility eing Inspected) Z 4c- <br /> FIRE DISTRICTS ON ATE A AL TIME D PARTURE TIME INSPECFIO E <br /> C <br /> 02 t2 <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> I. Business HMMP/Inventory On Site . 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 /> COMMENTS (Items marked "NO" above must be explained in this section) <br /> e. ci Obl-cltft -a- <br /> / 20&2 <br /> do.,y-C.1 Q 1 , <br /> REFERRALS (FOR OES USE ONLY) ❑SJ Ag ❑SJ Env Hlth OSHA [—] Fire ❑Air Dist <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actiony Must Ye Delivered To OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> / O' Z <br /> ACKNOWLE15GEMgNT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) w Busin s epr sen ti ature) <br /> ry <br /> D K FIAT' c l\0 (,l <br /> Name of Inspector and Fire Company 7/� WHITE COPY: OES <br /> CANARY COPY FIRE PREV1 <br /> 6-E%r ! � CY P IN COPY, BUSINESS ENTION REV 11/96 <br /> OES-HM 1 (9/00) <br />