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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 2' ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> �a.., STOCKTON, CA 95202-2709 <br /> t�FOpN BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> -1.4el, //l/ ryr L?q n 4 S s- <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> SOCo L.tl J�OcA_710^1 9sz/9 <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTOR NAME(AGENCY <br /> Z � 91?- s .� Lo/✓�z� '-ke&-7%110 t-T <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 t/ 8. 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 /> 4' iS 7a 77&— Y—T O,, <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 /> Bu <br /> 'gi ems epresentative Print Name an Title) Business resent ive t nature) <br /> WHITE COPY: OBS <br /> PINK COPY: BUS. <br /> V07 <br />