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COUNTY OF SAN JOAQUIN <br /> p4uh' 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 'fE FPHONE NUMBER <br /> 2e,9- 9r/- Adil- <br /> BUSINESS ADDRESS (Facility Being Inspected) ZIPCODE <br /> 3SOCO Gr/ �anJiaJE.e Zit/,�TO C K ro.✓ �s"2/q <br /> FIRE DISTRICT INSPECTION DATE JARRIVALTIME IDEPARTURETRAE INSPECTOR NAME/AGENCY <br /> 22- 9- 07- Z97 <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 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 /> C &0— OAJ fKra i na ,144-+ ¢e �2 <br /> L1,44 T A #4,r F Sr Q-A , c.4-,n/c-h <br /> L.Jtt2 nle y r7-10rr— <br /> oT <br /> 41 -221111 J!r 11f /Coe-c 04.1 7-2 7 Tit/fldfzTro�✓ <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 E]SJ Env Hlth ❑OSHA [:]Fire Q Air Dist <br /> 9-i2 -07 ❑ <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Busines ep�resentative(Signature) <br /> y A WHITE COPY: OES <br /> y ��!r �i �' � (%� PINK COPY: BUS. <br /> 4/07 <br />