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COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />s� ROOM 610, COURTHOUSE <br />`; 222 EAST WEBER AVENUE *S7 ?Sr <br />STOCKTON, CA 95202-2709 <br />BUS. (209) 468-3969 FAX (209) 468-0273 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSI/S11JNEM <br />��SS N E / <br />7r? -sir ��r �/�'_e (,d . .2 / 0/ <br />TE-L`EP ONE NUMBER <br />BUSIN/EJSS ADDRESS (Facility Being Inspected) / <br />til i,N e / / , A�' �t <br />ZIPCODE <br />9f <br />FIRE DISTRICT <br />Sid G-� <br />INSPECTION DATE <br />9/2s o 9— <br />ARRIV L TIME <br />116-0 <br />IDEPARTURETUVIE <br />Z cg Q <br />INSPECTOR AGENCY <br />ate- <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP Complete and Accurate <br />6. Facility Map Complete and Accurate <br />2. Chemical Description Pages Complete and Accurate <br />✓ <br />7. Chemical Inventory Complete and Accurate <br />3. Business Identification Page Complete and Accurate <br />I/ <br />8. Employees Familiar with HMMP <br />4. HMMP/Map Easily Accessible to Employees <br />L,.e <br />9. Hazardous Materials/Waste Properly Labelled <br />5. Training/Exercise Records Available <br />i ;� <br />A <br />10. Conditions noted that could increase risk of release <br />or hinder implementation of emergency lan <br />EXPLANATION OF FINDINGS AND COMMENTS <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 />(if appropriate) <br />Referral Actions <br />❑ SJ Ag ❑ SJ Env Hlth []OSHA ❑ Fire ❑ Air Dist <br />_ :KNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative (Print Name and Title) <br />R Q <br />�OL r. <br />Business Representative (Signature) <br />WHITE COPY: OES <br />PINK COPY: BU <br />4 07 <br />