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COUNTY OF SAN JOAQUIN <br /> Qea"I" 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 /> BUSINESS ADDRES (Facility Being nspected) ZIP CODE <br /> k La- A< <br /> FIRE DISTRICT INSPECPIONDATE ARRNALTIME DEPARTURETIME INSPECTOR NAMEIAGENCY <br /> �- ij�� Lt& LL rdI Pa <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGIT YES NO <br /> 1.Business HMMP Complete and Accurate y 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate 4K 7.Chemical Inventory Complete and Accurate zS' <br /> 3.Business Identification Page Complete and Accurate )p 8. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled d- <br /> 5.Training/Exercise Records Available 7( 10.Conditions noted that could increase risk of release <br /> v or hinder implementation of emergency Ian <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> 01 Ad 4U aoL 6�( A(17044 <br /> cU II <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 /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Represent v (Signature) <br /> ` WHITE COPY: OES <br /> I �,�� / vim_ PINK COPY: BUS. <br /> '�-J �jfT 4/07 <br />