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P� N COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> _ 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> tglzoAl i2etrss- Lec�c�-moo /Z�o29 <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP <br /> CC�ODE <br /> I Lf-?o(i WY 8-K �CKrT-o�-� / -227 <br /> FIRE DISTRICT INSPECTION DATE JARRIVALTIME DEPARTURE TIME I INSPECTOR NAMEIAGENCY <br /> /3 y- z&/-off /zcr"=' /0 Es <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 I/ 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate 7 S. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Available 10.Conditions noted that could increase risk of release <br /> or hinder implementation of emergency 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 /> El <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Busines / entative(SZnr <br /> OES <br /> v v ' /ej� / /, 01- �V e(.o /rte/4 WHITE COPY: 4/0 <br /> PINK COPY: BUS. <br /> 407 <br />