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0 0 <br /> OPgUIry P COUNTY OF SAN JOAQUIN <br /> ?•' • oma OFFICE OF EMERGENCY SERVICES <br /> a 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,Califomia 95206 <br /> Telephone: (209)953-6200 <br /> meq•. �p <br /> Fm:(209)953-6268 <br /> �/FGRE <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> INESS NAME ADDRESS(Facility Bei; Inspected) <br /> t U START D4rE(New Bus) INSPECTION DATE ARRIVAL IME DEPARTU IME IN PEC OR 'AMP <br /> )_10 <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 /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> U se ss Representat- (Pryq int Name and Title) Business Representative(Signature) <br /> 1 1 WHITE COPY: OES <br /> ���1--`I,,.✓///����- PINK COPY: BUSINESS <br /> REV 12/08 <br />