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„ COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a:. 2101 E.Earhart Avenue,Suite 300 I`� <br /> Stockton,California 95206 <br /> p=. Telephone:(209)953-6200 <br /> c-.., �► Fax:(209)953-6268 <br /> 9�IFCRN <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NA eta ADDRESS(Facility Being Inspected) <br /> ACCOU ff START DATE(New Bus) INSP"IO111DATE ARRIVALTIME IDEPARTURETIME INSP OR AME <br /> r� <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> . 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete andAccurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> INDEPENDENT SUPP Y <br /> 04 eu�omE2 C�csaasad eaMp,�y <br /> PAULA BAMER <br /> OPERATIONS MANAGER <br /> 200 E.LARCH RD. <br /> TRACY,C"5304 <br /> A DIVISION OF TEL(209)832-2038 <br /> FAX(209)832-2529 <br /> INDEPENDENT ELEV eySUPY INC. Paula.ba1C CELL mer@iusupply.com <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions (� Additional <br /> To Be Submitted By: 'J U” Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Tillel usme a resentahve(Signature) <br /> ^ ES <br /> PINKCOPY: US <br /> 1Y7 PINK COPY: BUSINESS <br /> REV <br />