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COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE <br />STOCKTON, CA 95202-2709 <br />c��iRoaN�P BUS. (209) 468-3969 FAX (209) 468-0273 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME <br />F,c 6" -/ <br />BUSINESS ADDRESS (Facility Being Inspected) <br />TELEPHONE NUMBER <br />117oP-- <br />ZIPCODE <br />FIRE DISTRICT <br />Zz <br />INSPECTION DATE <br />G -/� 0 7 <br />ARRIVAL TIME <br />3 To <br />IDEPARTURETIME <br />JINSPECTORNA AGENCY <br />L�we-u <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP CcSmplete and Accurate <br />6. Facility Map Complete and Accurate <br />2. Chemical Description Pages Complete and Accurate <br />7. Chemical inventory Complete and Accurate <br />3. Business Identification Page Complete and Accurate <br />8. Employees Familiar with HMMP <br />4. HMMP/Map Easily Accessible to Employees <br />9. Hazardous Materials/Waste Properly Labelled <br />5. Training/Exercise Records Available <br />/ <br />✓ <br />10. Conditions noted that could increase risk of release <br />or hinder implementation of emergency lan <br />EXPLANATION OF.FINDINGS AND COMMENTS <br />®ez� <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 />Q� ©7 <br />2l/ / <br />Follow-Up Inspection Date <br />(if appropriate) <br />Referral Actions <br />SJ Ag [] SJ Env Hlth OSHA ❑ Fire ❑ Air Dist <br />❑ <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />�es� �RSpre1vls�� e (PElpt and l� <br />r/T/ „(jl Vh v <br />Business Representative (Signature) <br />9k4Tfi_7PkM3PINK <br />WHITE COPY: OES <br />COPY: BUS. <br />4/07 <br />V <br />