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p,(�Ulp COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />2101 E. Earhart Avenue, Suite 300 <br />Stockton, California 95206 <br />Telephone: (209)00 <br />�4C/FOP�`P Fax: (209) 953-6268-6268 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME <br />ADDRESS (Facility Being Inspect ) <br />11 l I KLA-V% W a �J-. #� S <br />ACCOUNT # START DATE (New B=P(OTE <br />AR I AL TIME <br />/0,70 <br />DEPPARTU ,TIME <br />11/14Z -5 <br />I PE0(o <br />cZ <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK TPAIOUGH YES NO <br />. I. HMMP/Map On Hand and Easilyessible <br />6. Facility Map Complete a Accurate <br />2. Business Identification Page omplete & Accurate <br />7. Presence of Non- ' ed Regulated Chemicals <br />3. Business HMMP Co ete and Accurate <br />8. Employees F iliar with HMMP <br />4. Chemical Description Pages Complete and Accurate <br />9. Hazardous Materials/Waste Properly Labelled <br />5. Training Records Available <br />10. Conditions that would hinder implementation of <br />Emergency Plan or increase risk of release are absent <br />EXPLANATION OF FINDINGS AND COMMENTS <br />4 c-40-; <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions <br />To Be Submitted By: <br />Additional <br />Referrals/Notes: <br />ACKNOWLEDGEMEN,T OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />usiness ::,LZ,,e tat a riot Name and Title) Business Representative (Signature) <br />WHITE COPY: OES <br />PINK COPY: BUSINESS <br />REV 17J08 <br />I <br />