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>a�ty COUNTY OF SAN JOAQUIN <br /> so. .coG OFFICE OF EMERGENCY SERVICES <br /> Q 2101 E. Earhart Avenue,Suite 300 <br /> a ` Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> cq�lFoaNVP Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility,Being Inspected) <br /> A RiCb�XA I M . <br /> Rw gel <br /> A COUNT H START DAT ew Bus) INSPECTION DATE I ARRIVAL TIME DEPARTURE IME INSP O <br /> Q <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 - X <br /> Ix <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate 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 /> UpdA a a - 220 I <br /> U Il <br /> AL 1O <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 T'tle) Business sena[ve(Signature) <br /> WHITE COPY: OES <br /> I—le PINK COPY: BUSINESS <br /> REV 1'/0A <br />