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AM <br /> Pquty COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> Q' 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> -:_ Telephone: (209)953-6200 <br /> c'p<iiia'n`..N Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUST ESS NAME ADDRESS(Facility Being Inspected) <br /> Ka (A ax I U "oLg0 e <br /> ACCOUNT N START DATE(New us) INSPECTION DATE ARRIVALTIMEDEPARTU IME INSP CTOR AME <br /> 2 / U-( ?-� 14Iap [t,.2 a <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES,/NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> INSPECTION FOLLOW UP INFORMATION <br /> orrective Actions / Additional / <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usiness Representative(Prin Name and Title) Busme presentative(Signature) <br /> 1 b WMTECOPY: US <br /> 1r�1 <br /> PINK COPY: BUS[NESS <br /> REV 1706 <br /> i <br /> i <br />