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Q� N COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a` ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> �/c i ' �ri« F` 207- ,175/- o0 <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> jr-0 c rc T-�. / 9 S`Lo 7 <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIMEJIVSPEC MR NAME/AGENCY <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 d <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 0.Conditions noted that could increase risk of releas "Al <br /> or hinder implementation of emergency plan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> 3 <br /> vlpc AItAtcs c-oR:jT . <br /> w <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 /> 27 Z (if appropriate) SJ Ag ❑SJ Env Hlth []OSHA Fire ❑ Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OFS <br /> PINK COPY: BUS. <br /> X " PoM+t A °` V07 <br />