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�. COUNTY OF SAN JAUIN <br />OFFICE OF. EMERGENCY SERVICES <br />COUR E <br />4 EBER AVEN <br />� <br />k n <br />LIFORNIA 95202 <br />LS DIVISION (209) 468-3969 <br />9) 944-9015 <br />69PSPECTION <br />HAZARDOUS MOGRAM INSPECTION FORM <br />BUSINESS NAME TELEPHONE NUMBER <br />Zoe �i 31 <br />BUSINESS ADDRESS (Facility Being Inspected) <br />6G <br />FIRE DISTRICT INSPECTIO r ATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br />rs' z � os �f31®r <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES O FACILITY INSPECTION YEY NO <br />1. Business HMMP/Inventory On Site Ll 17. Facility Map Complete and Accurate <br />2. HMMP/Map Easily Accessible to Employees 8. Chemical Inventory Complete and 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. Hazardous Materials Being Properly Handled by Employee r/ <br />5. Material Safety Data Sheets (MSDS) On Site 112. 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 />ate�d . <br />1 <br />� <br />I,+� ra`zt . [�tlN ou4t4,. <br />ro tZ )Leq 6,�td wa,4 Y/4 <br />REFERRALS ❑ SJ Ag ❑ SJ Env Hith ❑ OSHA ❑ Fire ❑ DA ❑ <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Ac ionsMust be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br />Z�l 3�Q.S <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Businer <br />s�s Representative (Print Name and Title) <br />Business Representative (Signature) <br />/ <br />Name of nsp r Agency Fire Co. (If Appropriate) <br />7 C E -0-P <br />WHITE COPY: OES <br />I REV 9/02 <br />cS <br />PINK COPY: BUSINESS <br />