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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY Esto,97, <br /> a ROOM 610 HOUSE <br /> 222 WEBER AVENUE <br /> CKTON, CA 95202-2709 <br /> ����FO•S�`' BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> � cJe,tt{S �!n 733 <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> ZO S k'e-lexr D✓✓FIRE DISTRICT INSPECTION D TE ARRIVAL TIME DEPARTURE TIME INSPECTOR NAMEAGENCY <br /> 2 S�LS�O9 /Poe <br /> A t cTl <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 MaterialsAVaste Properly Labelled <br /> 10.Conditions noted that could increase risk of releas <br /> 5.Training/Exercise Records Available or hinder implementation of emer enc lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <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 /> (if appropriate) ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑ Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> 't'� WHITE COPY: OES <br /> L PINK COPY: BUS. <br /> LA L,eJ\ am <br />