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COUNTY OF SAN JOAQUI <br /> �aR coc OFFICE OF EMERGENCY SERVICES <br /> r' ? ROOM 610, COURTHOUSE <br /> ` 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> "iii P BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINFS NAME TELEPHONE NUMBER <br /> Reaetj LLL 1 6 <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> A0 C-/"�41 gb'Za� <br /> RE DISTRICT INSP N D ARRIVAL TIM DEPARTURE TIME INSPECTOR NA AGENCY <br /> c S <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate V 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate 7.Chemical Inventory Complete and Accurate vo <br /> 3.Business Identification Page Complete and Accurate V 8.Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees .Hazardous Materials/Waste Proptrly Labelled <br /> 5.Training/Exercise Records Available .Conditions noted that could increase risk of releas <br /> or hinder implementation of emergency lan <br /> EYjLPLANATION OF FINDINGS ANxQ COMMENTS <br /> K" A4 CIO 04.^o u o <br /> o n v ctrt r O ?` fo c l o <br /> X Ila— dlo'q-A-.r oj *12.44l0' c <br /> ,_?_x fC Aa 115. <br /> X Z80 cxf. Arqe <br /> p <br /> / 4 f,/Al, <br /> reg<e t r^ ed Idcd<a4.. lcbi-ex . <br /> 304 g0.l�QK "1 �'W1TUt�4 �Ct� <br /> NOTE: All HMMP documents except for the Facility Map can be treated 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) E]SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑ Air Dist <br /> W r, lS Z007 ❑ <br /> ACKNOW19EDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RE ULTS <br /> Business Representative(Print Name and Title) Business R tresent I <br /> ive(Signature) <br /> WHITE COPY: OES <br /> PINK COPY: BUS. <br /> Bc ew MO -Dlr46 ACIA . 4/07 <br />