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Q, N COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> ..C�C/FOR��r•• 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 /> ot-k T - TaM O' -*-- /tv- 39- 7 d.- <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> &Y'05- A-AA O AM 04 1; I>R STv cILTo SZ 10 <br /> FIRE DISTRICT INSPECPIONDATE ARRIVALTIME DEPARTURETQvTE INSPECTORNAMFJAGENCY <br /> 2L 6P 07 9 C34 41VLVC'7_L_ Aei./ /OrT <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMR'IP Complete and Accurate 6.Facility Map Complete and Accurate <br /> 2. Chemical Description Pages Complete and Accurate Ve 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 bl-11, 9.Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Available /10.Conditions noted that could increase risk of releas <br /> ✓ or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> L ^H L u A4e-Y 1 /LL. <br /> P tr'ZS 7V Ter- LrTV cc704-CleCf&r. <br /> lel /1�c2-3� �o At) D /f-b,DI R•F-- Se .�f1M sb SNocJ <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 F]SJ Env Hlth []OSHA Fire Air Dist <br /> -7- 3 - (07 ❑ <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Busin ssR resentative 'gnature) <br /> ( WHITE COPY: OES <br /> PINK COPY: BUS. <br /> 7 <br />