Laserfiche WebLink
P4�u'N COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a ROOM 610, COURTHOUSE <br /> y. 222 EAST WEBER AVENUE /2 7 / <br /> :. <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 /> ATA 77 Me 6 , Poo-ep3Z-662. <br /> BUSINESS ADDRESS(F,a�ccility Being Inspe ed) ZIP CODE <br /> 107-7 ? /iii c,*,-o &r c ✓e- 2of• Lo ol i 95-2 �Lo <br /> FIRE DISTRICT RVSP ON ATEARRIVAL TIME DEPARTURE TIME INSPECTOR NAME/AGENCY <br /> LW e2� /0 145, Lj. 71eoe <br /> DOCUMEV REVIEW YES NO FACILITY WALK TFM n1 Uld YES NO <br /> 1.Business HMMP Complete and Accurate E/ 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate V 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate 8. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Available <br /> 10.Conditions noted that could increase risk of release <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> dt GSC �_jO04 J1 J01 O fee— e- C IC'Ca/i <br /> e- A"CLN . <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 /> 12008` (if appropriate) 11 SJ Ag F]SJ Env Hlth OSHA [:]Fire ❑ Air Dist <br /> 11 <br /> .CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> PINK COPY: BUS. <br /> a al t t:.`1j'-- 4/07 <br />