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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 3 ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> 4 STOCKTON, CA 95202-2709 <br /> "�IFGaa p BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONF.NUMBER <br /> � , ' s -r-ktt aANI =M C-- 20 -373- U <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIPCODE <br /> 5733Ql�CI = vc, 5,-oc-tc 52-o7 <br /> FIRE DISTRICT INSPECTION DA'L'E ARRIVAL TIME IDEPARTURETIME JINSPECRNAMEIAGENCY <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 Co nd Accurate 7.Chemical Inventory Comple ccurate <br /> 3.Business Identific age.Complete and Accurate8.Employees Fa ' ' with HMMP <br /> 4. RMMap Easily Accessible to Employees 9.Haza Materials/Waste Properly Labelled <br /> ARKonditions noted that could increase risk of releas <br /> raining/Exercise Records Available or hinder implementation of mergency plan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> .SD /Ss . <br /> _ CURT SIVERLING <br /> GENERAL MANAGER AND SHAREHOLDER <br /> BJS463®BJSRESTAURANTS.COM ¶ <br /> 5733 PACIFIC AVE <br /> STOCKTON,CA 95207 <br /> (209(3734660 PHONE <br /> j (209)373-4665 FAX <br /> W W W.BISRESTAURANTS.COM <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 E]SJ Env Hlth []OSHA ❑Fire ❑ Air Dist <br /> ACKNO EDGEMENT OF REVIEW AND RECEIPT OF INSPECTIO RESULT <br /> Busines present ativ int Name and Title) Busi s§Re es t iv (Signature) <br /> \ /Y WHITE COPY: OES <br /> 1/p PINK COPY: BUS. <br /> oL F vl 4107 <br />