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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 /> .hi BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> LvsSrWie- 209- y77-2 S/Lo <br /> BUSINESS ADDRESS (Facility Being Inspected) ZIPCODE <br /> 7,2Fr'3 !✓. lv'44CH G✓• 95-L07 <br /> FIRE DISTRICT INSPECTION DATE JARRIVALTIME DEPARTURETIME JINSPECFORNAME/AGENCY <br /> 71 d -6- OJ 2: oo L...izL AcLW /or= <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate 8. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 10.Conditions noted that could increase risk of releas <br /> 5.Training/Exercise Records Available l <br /> vl� or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> u,�Iil/E3� 1'D /mac• .1/��C To S3� ami A�� <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 Follow-Up Inspection Date Referral Actions <br /> (if appropriate) 11SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑ Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OFS <br /> BUS <br /> PINK COPY: BUS. <br /> M.et- jA O LI 4107 <br />