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COUNTY OF SAN JOAQUIN <br />PgUrry <br />OFFICE OF EMERGENCY SERVICES <br />`a ROOM 610, COURTHOUSE Z Z3 <br />- <br />222 EAST WEBER AVENUE <br />.. ..�P STOCKTON, CA 95202-2709 <br />BUS. (209) 468-3969 FAX (209) 468-0273 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS N� <br />TELEPHONE NUMBER <br />N6 <br />goo <br />BUSINESS ADDRESS (Facility Being Inspected) ^i <br />d <br />ZIPCODE <br />7 <br />320 2 S 7-v-o,c /v . ika_ <br />. <br />FIRE DISTRICT <br />INSPPE N ATTE <br />A NAL TIME <br />DE ARTURE TIME <br />SPEC/TOR NAMF/AGENCY <br />/ f a-C_O <br />/ <br />rP CO <br />/ZO� <br />�6-��� e- <br />DOCOMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP Complete and Accurate <br />t/ <br />6. Facility Map Complete and Accurate <br />v <br />2. Chemical Description Pages Complete and Accurate <br />7. Chemical Inventory Complete and Accurate <br />3. Business Identification Page Complete and Accurate <br />t,8. <br />Employees Familiar with HMMP <br />4. HMMP/Map Easily Accessible to Employees <br />9. Hazardous Materials/Waste Properly Labelled <br />>. Training/Exercise Records Available <br />A <br />10. Conditions noted that could increase risk of release <br />/I <br />or hinder implementation of emergency lan <br />EXPLANATION OF FINDINGS AND COMMENTS <br />�� �J, c -Y ✓T p -� C7 s' SO Cif O vI <br />W 4 �-- Gt �ia �✓ d / 2 c� v <br />o To .✓t <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 <br />Follow -Up Inspection Date <br />Referral Actions <br />(if appropriate) <br />❑ SJ Ag ❑ SJ Env Hlth ❑OSHA ❑ Fire ❑ Air Dist <br />.:K OWI EMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative (Print Name and Title) <br />Business Representative (Signature) <br />f w'3�y t , r A /'Q�,� feffvlC1�PINK <br />PPOGI M Ir' wlJ�7(�f1*�a/ Cy"T-� <br />WHITE COPY: OES <br />COPY: BUS. <br />4/07 <br />