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9 0 <br />COUNTY OF SAN JOAQUIN <br />e° Foy OFFICE OF EMERGENCY SERVICES <br />w ` j 2101 E. Earhart Avenue, Suite 300 <br />Stockton, California 95206 <br />-_ Telephone: (209) 953-6200 <br />• 6••.: �p Fax: (209) 953-6268 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />I E NAME <br />ADDRESS,(Facility Being I spected) <br />AC # START DATE (New us) <br />I SP <br />I DATE I <br />ARRIVAL TIME <br />IDEPARTURE TIME <br />INS <br />ECP N E <br />DOCUMENT REVIEW <br />INSPECTION RESULTS <br />YES NO FACILITY WALK THROUGH YES NO <br />1, HMMP/Map On Hand and Easily Accessible <br />6. Facility Map Complete and Accurate <br />2. Business Identification Page Complete & Accurate <br />7. Presence of Non -Listed Regulated Chemicals <br />3. Business HMMP Complete and Accurate <br />8. Employees Familiar with HMMP <br />4. Chemical Description Pages Complete and Accurate <br />9. Hazardous Materials/Waste Properly Labelled <br />5. Training Records Available <br />10. Conditions that would hinder implementation of <br />Emergency Plan or increase risk of release are absent <br />EXPLANATION OF FINDINGS AND COMMENTS <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions <br />ro Be Submitted By: <br />Additional <br />Referrals/Notes: <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business esent . (P ' t e and Tide) <br />//M r �� <br />Business pres t Signature) WHITE COPY: OBS <br />PINK COPY: BUSINESS <br />,j REVtwos <br />