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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a Za ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE - /-2, P 671 <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NA TELEPHONE NUMBER <br /> 7— X061_11_�v <br /> BUSINESS ADDRESS(Facility Being InspTce d) ZIPCODE <br /> 0 S• �r� o✓' �Gt SOC. �041 95-2-0 <br /> FIRE DISTRICT INSPE O DATE ARRI%A IME DEPARTURETIME INSPECTOR NAME/AGENCY <br /> s ,G��I161610� o Toa /0j-0 ',Z 'O'f-Lo e-2- <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate 8. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Available <br /> 10.Conditions noted that could increase risk of release <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> _ Kt1_; V 6C�_ C 6C4 s ;z <br /> / /O an -� .�1` Azo 4 u" <br /> 7 . <br /> •�c esy �' Lill <br /> ro <br /> NOTE: All HMMP documents except for the Facility Map can be created and updated on the San Joaquin County <br /> HMMP Compliance Website at www.sjoesdata.org. Contact OES for user name and password. <br /> INSPECTION FOLLOW-UP INFORMATION <br /> Corrective Actions Must Be Submitted By Follow-Up Inspection Date Referral Actions <br /> j_V-'.4 7 Z O 61R, (if appropriate) ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑ Air Dist <br /> 11 <br /> ICNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business epresiv (Print Name and Title) Business Rep esentativ Si ature) <br /> WHITE COPY: BOES <br /> US <br /> C� PINK COPY: BUS. <br /> 4/07 <br />