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COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />r.' s 2101 E. Earhart Avenue, Suite 300 <br />Stockton, California 95206 <br />• <br />-• ^ Telephone: (209) 953-6200 <br />•c -- <br />�P Fac: (209) 953-6268 <br />'dtieoeN <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME <br />ADDRESS (Facility BeingIns cted) <br />99 f��i <br />�rzor <br />uF� ,yE <br />28Lz9 s r <br />.ACCOUNT # <br />START DATE (New Bus) <br />1INSPECTION DATE <br />ARRIVAL TIME <br />DEPARTURE TIME <br />INSPFrCrOR NAME <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH <br />YES NO <br />1. HMMP/Map On Hand and Easily Accessible <br />5. Facility Map Complete and Accurate <br />2. Business Identification Page Complete & Accurate <br />6. Employees Familiar with HMMP <br />3. Business HMMP Complete and Accurate <br />7. Training Records Available <br />✓t <br />4. Chemical Description Pages Complete and Accurate <br />8. Unsafe Conditions Observed (see details below) <br />EXPLANATION OF FINDINGS AND COMMENTS <br />ffiTUFFSHED' <br />Stora10 Buildings S 6 ON$ bL#:661654 <br />Kirk Sanders <br />2829 South Highway 99 General Manager <br />F <br />- -- -- Stockton, CA 95215 <br />office 209-462-8833 <br />_ mobile ( 209) 321-9548 <br />ksanders®tuffshed toll free 800-593-8833 <br />tuffshed.com facsimile 209-465-7970 <br />y <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions <br />Additional <br />To Be Submitted By: <br />Referrals/Notes: <br />CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RES LTS _77— <br />Business Representative (Print Name and Title) Business se (Signature) <br />WHITE COPY: OES <br />5V%�Q('V 150r PINK COPY: BUSINESS <br />xEv am <br />