Laserfiche WebLink
c1,* � <br /> i� COUNTY OF SAN JOAQUIN <br /> }Q a' OFFICE OF EMERGENCY SERVICES <br /> ROOM 610,COURTHOUSE <br /> �' t} 222 EAST WEBER AVENUE <br /> STOCKTON, CALIFORNIA 95202 <br /> .c!95,'s ORN\A HAZARDOUS MATERIALS DIVISION(209)468-3969 <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> C0.V0. IVI 01— S <br /> BUSINESS ADDRESS (Facility Being Inspected) <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME JINnECTIONTYPE <br /> o a a Z 07 /O j— o" e <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees S.Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/IIMMP 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.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 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) <br /> 2- <br /> � o <br /> 2 X / 00 * 4-j-1 /-cu <br /> o0 f Ce .7c- <br /> /oo <br /> � XS �b�aµ 'v: cva..� f •� 't <br /> 00 <br /> 0.t S- 'h L--c Z-006 <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrve Actions M t b eli red t OES B Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> 7) !f- ^ l P/ <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RES TS <br /> Business Representative(Print Name and Title) Business R,pr entat e(Si ur <br /> Na of nspec r Agency Fire Co. (If Appropriate) WHITE COPY: OFS REV 9/02 <br /> a � �. L z PINK COPY: BUSINESS <br />