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'R" N COUNTY OF SAN JOAQUIN <br /> s� •�p� OFFICE OF EMERGENCY SERVICES <br /> Q' a ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> CAtIFCRN�P BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> L�ontPrl.,7`S -AZ-5-76d- -e-1 0-5709 g7tf - Fkll <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIPCODE <br /> zsos— I�A_.e_CN '?rF_ <br /> FIRE DISTRICT INSPP. ON ATE ARRIVALTIME DEPARTURETIME INSPECTORNAMEIAGENCY <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 S. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 5.TrainingBxercise Records Available 10.Conditions noted that could increase risk of release <br /> or hinder implementation of emergency lan <br /> EXPL'INATION OF FINDINGS AND COMMENTS <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) 11SJ Ag [—]SJ Env Hlth ❑OSHA ❑Fire ❑ Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Busmes Ripresentative(Print Name and Title) Busine a esenlative( gnat re) <br /> WHITE COPY: OES <br /> PINK COPY: BUS. <br /> 41071 <br />