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COUNTY OF SAN JOAQUIN <br />�o..coG OFFICE OF EMERGENCY SERVICES <br />Q a 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 />BUSINESSME <br />AT-Me6 [ 0 �-Y <br />TELEPHONE NUMBER <br />koo-r32-tr&62- <br />BUSINESS ADDRESS (Facilit eing In cted) <br />4 J IF W 9c. -V- VV -c Law '� �-oc�� <br />ZIPCODE <br />95- Z' -Z <br />FIRE DISTRICT <br />JINSP7TIONDOEJARRNALTIME <br />0 <br />162-0 <br />D�©TU� E <br />IN�TOR� AGEN?l'9 <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES O <br />1. Business HMMP Complete and Accurate <br />1/� <br />_ <br />6. Facility Map Complete and Accurate <br />2. Chemical Description Pages Complete and Accurate <br />7. Chemical Inventory Complete and Accurate <br />l <br />3. Business Identification Page Complete and Accurate <br />8. Employees Familiar with HMMP <br />4. HMMP/Map Easily Accessible to Employees <br />9. Hazardous Materials/Waste Properly Labelled <br />5. Training/Exercise Records Available <br />/ <br />�1/ <br />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 c- + o&4.��� e <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 Actionsust Be Submitted By <br />Wl�h <br />Follow -Up Inspection Date <br />(if appropriate) <br />Referral Actions <br />❑ SJ Ag ❑ SJ Env Hlth ❑OSHA ❑ Fire ❑ Air Dist <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative (Print Name and Title) <br />A (' Tr " AAD <br />Business Representative (Signature) <br />WHITE COPY: OES <br />PINK COPY: BUS. <br />4/07 <br />