Laserfiche WebLink
COUNTY OF SAN JOAQUIN <br />x •; OFFICE OF EMERGENCY SERVICES <br />})! ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE <br />i <br />STOCKTON, CALIFORNIA 95202 <br />HAZARDOUS MATERIALS DIVISION (209) 468-3969 <br />FAX (209) 944-9015 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BU I SS NAME <br />_4C <br />TELEPHONE NUMBER <br />BUSINESS ADDRESS (Facility Being Inspect/edd)) <br />FIRE DISTRICT <br />INSPECTION DATE JARRIVAL TIME <br />is- or <br />DEPARTURE TIME <br />A"< <br />1INSPECTIONTYPE <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br />1. Business HMMP/Inventory On Site <br />7. Facility Map Complete and Accurate <br />2. HMMP/Map Easily Accessible to Employees <br />8. Chemical Inventory Complete and Accurate <br />3. Bus ID Page/HMMP Complete and Accurate <br />9. Employees Familiar with HMMP <br />4. If Business is a Hazardous Waste Generator, <br />are Hazardous Waste Manifests On Site? <br />10. Plant Operations Appear Safe L� <br />11. Hazardous Materials Being Properly Handled by Employee <br />5. Material Safety Data Sheets (MSDS) On Site <br />12. Hazardous Materials Properly Stored and Labeled <br />6. Current Training Records On Hand <br />13. Soil and Facility Appear Non-Contaminated <br />COMMENTS (Items marked "NO" above must be explained in this section) <br />c26ro� aa/'�. Jvi-➢� r ?Z, �d-C <br />Q eo 7l- z1�- 01� <br />REFERRALS ❑ SJ Ag ❑ SJ Env Hlth ❑ OSHA ❑ Fire ❑ DA ❑ <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions Must be Delivered to OES By <br />gr_ 2S- d T <br />Follow Up Inspection Date <br />OES Inspector Name Performing Follow Up <br />ACKNOVYLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTI <br />Businesentativ <br />es a r! _Z <br />(Print Name and Title)) <br />us epre ntativ <br />(Si nature) <br />N7/.fPXtor //JJ A$ ency ^ F' Appropriate) <br />r �fsCo e�9✓c a <br />WHITECOPY: OES <br />PINK COPY: BUSINESS <br />REV 9/02 <br />