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Q, N COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> r' ? ROOM 610, COURTHOUSE <br /> Wt. <br /> 4 222 EAST WEBER AVENUE 82 Z <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME` l TELLE9PHONENUM 3ER <br /> VoAlfv -4 a-C..1 T n i L �ei"C WI tJl T:✓1.c__. �2 / ^p�/z <br /> BUSINESS A11DRESS(Facility Being Inspected) ZIP CODE <br /> 3S:fo S. N w 9 9, S¢-0C_/_4"\ 4' rz/ .s- <br /> MEDISTRICT INSPBgTIODAM ARRIVALTIME I DEPARTURE TIME 1INSPECTORNAMEIAGENCY <br /> r,to •- 9 /8 o s <br /> /0 11 <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1. Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate 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 /V pe <br /> 10.Conditions noted that could increase risk of release <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND( COMMENTS <br /> I <br /> A(C — � A10 IMct4- SI.�ot ) a,GJ s0.CewT O✓op4e USS <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 /> // (if appropriate) ❑SJ Ag ❑SJ Env Hlth OSHA ❑Fire ❑ Air Dist <br /> �e �ev*6e✓ 1� Z008, ❑ <br /> CKNIIOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usiness Representative(Print Name and Title) Business Representative(Signature) <br /> / WHITECOPY: OES <br /> l / k4'Vvw <br /> PINK COPY: 4107 <br />