Laserfiche WebLink
COUNTY OF SAN JOAQUIN <br /> p c 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 /> BlrSSNAMETELEPHONE NUMBER <br /> /eFacia r/ 2 ` <br /> BUSINESS ADDRESS( lit Being Inspeted) <br /> S^ <br /> FIRE DISTRICT INSPE IO DMfE JARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> 07 Zizocl� <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1.Business HMMP/Inventory On Site 7.Facility Map Complete and Accurate <br /> 2.HMMP/Map Easily Accessible to Employees .Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page HAIMP 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? A A 11.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 V1 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS(Items marked"NO"above must be explained in this section) <br /> it1,k2 <br /> �a 6 4S , <br /> 04 - ;PrO LI'V� c o �o e vY /. <br /> CRC v.� cam. <br /> REFERRALS ❑SJ Ag ❑SJ Env Hhh ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Correc 've Actio s Must be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> i I � 200-7 <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> a RIF L AI'lli l s ' <br /> Namespqctor Agency Fire Co.(If Appropriate) WHITE COPY: OFS <br /> 212 /,0 ar17 eJr PINK COPY: BUSINESS REV 9/02 <br />