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1.i COUNTY OF SAN JOA UIN '%04°4gO1 . OFFICE OF EMERGENCY ERVICES <br /> 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected // <br /> ror T A io.t ! 90 gS. �f asoa c� J4 ,1 &ak.4 9120f, <br /> ACCOUNT& START TE(New s) INSPECTIOND TE ARRIVAL TIME D ARTURE TIME IN ECTOR N M <br /> Aecw ?- /2 z'f o? / - I hSQv6wez <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Access'We 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Co e&Accurate 7. Presence of Non-Listed Regulated 996cals <br /> 3.Business HMMP Com and Accurate 8. Employees Familiar with MWK <br /> 4.Chemical D ription Pages Complete and Accurate 9. Hazardous Materials/ to Properly Labelled <br /> 5.Training Records Available 10. Conditions th would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> 1 x SY OH . va't o I d� <br /> IX t. - <br /> l yK 2�S'O n(td/ 0-100tJN _ ✓eo t41 . �t0 LA3 o k L wL <br /> 7S �i'L I l0t/� 4 W`� ✓�tl...1.V\ V"'�LS T Gl K 1�, <br /> 2 /� SS � � otti C>A✓t.( o . <br /> X e e <br /> �a YJ�1 Y1 vl o o W v,, ✓-Lx o1x e— <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Zn;= PINK <br /> ntative(Signature) WHITE COPY:COPY: BUSINESS <br /> REV 1 <br />