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M a <br />qury. COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />a' 2101 E. Earhart Avenue, Suite 300 <br />Stockton, Califomia 95206 <br />Telephone: (209) 953-6200 <br />c'•.. �P Fax: (209) 953-6268 <br />,SIF OPN <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />B SS NAME <br />JC <br />ADDRESS (Facility Being Inspected) <br />ACCOUNT # <br />START DATE (New Bus) <br />INSPECHON DATE <br />O <br />ARRIVAL TIME DE A TU TIME <br />IN PE OR A <br />INSPECTION RESULTS <br />DOCUMENT REVIEW 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 />e <br />iv <br />U H <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions <br />To Be Submitted By: <br />Additional <br />Referrals/Notes: <br />CKNOWLEDGEMENT OfrREVIEW AND RECEIPT OF INSPECTION RESULTS <br />usmess Representative (Print Name and Title) Busm s Representative (Signature) <br />O - <br />WHITE COPY: OEs <br />PINK COPY: BUSINESS <br />tsF.v twos <br />