Laserfiche WebLink
:0 475 <br /> AML -Dr <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> RECEIVED <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE DEC 16 2004 <br /> STOCKTON, CALIFORNIA 95202 <br /> SAN JOAQUIN COUNTY <br /> HAZARDOUS MATERIALS DIVISION(209)468-3969 OFFICE OF EMERGENCY SERVICES <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> PSE - \ Oa \000 <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YE NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site j 7.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? 1 L Hazardous Materials Being Properly Handled by Employee <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 /> Ott v i '." d� ����� +�'C \S <br /> REFERRALS ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Busine s Representative(Signature) <br /> Name of Inspector Agelicy Fire Co. (If Appropriate) WHITE COPY: OES <br /> j' ��`c�. j �1• � ���1 PINKCOPY: BUSINESS REV 9102 <br />