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at,Quly c COUNTY OF SAN JOAQUIN <br /> ?' '•�� OFFICE OF EMERGENCY SERVICES <br /> w` 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> -' Telephone:(209)953-6200 <br /> 06' • Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS S NAME ADDRESS(Facility Being Inspected) <br /> Ilio rhaikn <br /> 51- <br /> ACCOUNTf START DATE(New Bus) INSPECTION DATE I ARRIVAL TIME IDEPARTURE TIME INSPECTOR NAME <br /> -5'Y ti0 Oq 5(�- 1 t a-2 a <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 and Accurate 9. Hazardous MaterlaWWaste 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 /> 9 <br /> 19 <br /> M <br /> i <br /> J <br /> I <br /> s <br /> ) <br /> 9 <br /> k <br /> 9 <br /> E <br /> k <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) e#e_ Business Representative(Signature) <br /> YWn{'lG{ WHITE COPY: US <br /> it 1�.—(/ `_'_""_—" PINK COPY: BUSINESS <br /> REV 12JOE <br />