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E. <br />COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />?.. ROOM 610, COURTHOUSE /.2 <br />222 EAST WEBER AVENUE <br />STOCKTON, CA 95202-2709 <br />BUS. (209) 468-3969 FAX (209) 468-0273 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME <br />TELEPHONE NUMBER <br />AT/&I 9,,kdj-A1 <br />Y-6-- �41902 <br />BUSINESS A�DD4ESS (Facility Bein Inspe ed) <br />ZIP CODE <br />9 i�/, k v -e • <br />'� r2-0 7 <br />FIRE DUSTRICT <br />INSPEC90NDATE <br />IVAL TtNiF. <br />I DEPARTURE TIME <br />INSPECTOR NrAGENCY <br />E1_5L0 <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 />t__ <br />7. Chemical Inventory Complete and Accurate <br />3. Business Identification Page Complete and Accurate <br />8. Employees Familiar with HMMP <br />C� <br />4. HMMP/Map Easily Accessible to Employees <br />_.W/07. <br />9. Hazardous Materials/Waste Properly Labelled <br />5. Training/Exercise Records Available <br />10. Conditions noted that could increase risk of release <br />or hinder implementation of emergency lan <br />EXPLANATION OF FINDINGS AND COMMENTS <br />C GG r -P_Pl- 7- <br />f/a11U'"a- 0. <br />C Qty <br />NOTE: All HMMP documents except for the Facility Map can be created and updated on the San ,Joaquin Count <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 />Referral Actions <br />(if appropriate) <br />SJ Ag [] SJ Env Hlth OSHA E] Fire [] Air Dist <br />CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />ve (Print Name and Title) <br />1"'I dd <br />Business Re7cttAc <br />Business Representative (Signature) <br />WHITE COPY: OPS <br />'r ­(Z!7 <br />IL <br />PINK COPY: BUS. <br />4/07 <br />v �� <br />