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COUNTY OF SAN JOAQUIN <br /> °►`�°1" ° OFFICE OF EMERGENCY SERVICES ^ <br /> b 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> t`gtiFOR(':P Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> �C*(TOnt its �E't-`�tA(r l,.l ak..lc> Lntc. Lo`l�- <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE I ARRIVAL TIME DEPARTURE TIME INSPECTOR NAME <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Acate 7. Presence of Non-Listed Regulated Chem' <br /> 3.Business HMMP Complete and rate 8. Employees Familiar w' P <br /> 4.Chemical Descriptioges Complete and Accurate 9. Haza aterials/Waste Properly Labelled <br /> 5.Trainingords Available 0. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> /`1'r us�n/tTiS L-fG�lArsf n.ls cz zMc.9�.✓ s'.. /"/ c-#--�.9-� <br /> 9u i7L^3. <br /> INSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> o Be Submitted By: Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usmess Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> Q/� PINK COPY: BUSINESS <br /> "" ���`�.1 REV 11108 <br />