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p4qu,k• COUNTY OF SAN JOAQUIN'•per OFFICE OF EMERGENCY SERVICES <br /> a' a 2101 E.Earhart Avenue, Suite 300 <br /> W-' .. X <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> 106 N`PFax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> ELEvexj -C' 3z— Co Z7 tea. (/.,tci loa. SZo7 <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE I ARRIVAL TIME DEPARTURE TBvIE INSPECTOR NAME <br /> 2-- 1 - /L ///S <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 5. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 6. Employees Familiar with HMMP <br /> 3.Business HMMP Complete and Accurate 7. Training Records Available <br /> 4.Chemical Description Pages Complete and Accurate 8. Unsafe Conditions Observed(see details below) <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> I y MP /Vor eA-31L- Y �SSi LE c�^(NLDS��� 7Jr st4+IT <br /> Xq L./ &4e-A-6- 7"0 /' nWjS r7L PLAP4 <br /> A6/ -T /-064 At AIA-S /^/Cmc-114t t-r1: i� HEMP o00,0-in ,-/ z✓A:5 <br /> Mrs i�✓tr <br /> A/ L c 7b �I Gc�t2 Y ori MN( P , <br /> !n- ��9OLoYo--Lr w�l-s .✓aT fiF/t-sl�r•4� n/iT/-I M � ©� wl�Ar <br /> '—r tcY iOLA. t t,./A-S <br /> A- Ck Lc�l r S ACcu2A 5� <br /> F I -f 6` PLAPCr 7 '<^/'OS/ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Z' /5--- 12— Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> '�`KULW J)ER M C' PINK COPY: BUSINESS <br /> REV 4/10 <br />