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-4 COUNTY OF SAN JOAQUIN <br /> A4ul" OFFICE OF EMERGENCY SERVICES <br /> 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 /> BUSINESS, ` <br /> ADDRESS <br /> '(Facility Being Inspected) \ � ZIPPC,ODE <br /> FIRE DISTRICT f INSPECTION DATE AKRIVALITME DEPARTURE WME. I INSPECTOR NAME/AGENCY/ <br /> DOCUMENT REVIEW YIDS NO FACILITY WALK THROUGH YES NO <br /> 1. Business HMMP Complete and Accurat C. Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Coin to and Accurate 7.Chemical Inventory Complete and A rate <br /> 3. Business Identification Paa omplete and Accurate 8. Employees Familiar with P <br /> 4. HMMPIMap Easi ccessible to Employees 9.Hazardous Mat saste Properly Labelled <br /> 10. Conditio oted that could increase risk of release <br /> 5.Training/Excelcise Records Available or hinder implementation of ernerZency plan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> CC !/L d err o�f .✓ G <br /> NOTE: All HMMP documents except for the Facility Map can be created and updated on the San Joaquin County <br /> I-IMMP 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) F]SJ Ag []SJ Env Hlth OSHA ire ❑ Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) I Business Repre tive(Signature) <br /> WHITE COPY: OES <br /> PINK COPY: flUS. <br /> 4107 <br />