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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue,Suite 300 <br /> ` Stockton,California 95206 <br /> — <br /> Telephone:(209)953-6200 <br /> •cs ,_ 'P• Fac:(209)953-6268 <br /> 4�rFGPN HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSI SS NAME ADDRESS(Facility Being Inspected) <br /> C rdJJ <br /> ACCOUNT# START DATE(New Bus) IN SPECCION DATE ARRIVAL TIME DEPARTURE TIME JINSPWTOR NAME <br /> lot QL* 2 -"-l0 t l �_ — / <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: x Referrals/Notes <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPEC I N RESULTS <br /> usmess Representative(Print Name and Title) Busm s Representauv ignature) <br /> WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> d%AS 6( aev 12/081 <br />