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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ? ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> (,FOp BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> 1, _ _1_6 <br /> 1�� I IS I�eZD ✓ Llneur /C /2S'z 7 •-- <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> G y r' S .e- rl Si 5s z.os — <br /> FIRED[STRICT INSPg_(,�/QOND TE ARRIVAL TIME DEPARTURE TIME INSPECTOR NAMEIAGENCY <br /> ✓ �Zy�Of' 'V" AL& 6-A/ <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> I.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 10.Conditions noted that could increase risk of release ✓ <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <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 /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> ^1\� WHITE NKC COPY: OES <br /> BUS J� PINK COPY: BUS. <br /> 4/07 <br />