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t_." <br /> �,N COUNTY OF SAN JOAQUIN <br /> �1P�,01OFFICE OF EMERGENCY SERVICES <br /> y z< ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE 2o. <br /> -jj�iSTOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> o6• 8'06832-6&e <br /> BUSINESS ADDRESS(Facility Being Inspe ted) l ZIPCODE <br /> 2.-2- N. jC-re-a4o ti 751 �o <br /> FIRI,DI; I INS /C-PO/NODS- Al2R 1 0E DEPA(R�O INSPECTOR NAA NC <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate Vi6.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 /> 5.Training/Exercise Records AvailableN 10.Conditions noted that could increase risk of release <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> 3 :Ve- eo.A <br /> pa�.r 0-0 ,1 d O C-S- JAa �C e�✓ Y Q a LA ac- — !✓► 4O f y-►cj •a <br /> /b — d�✓�r-,j^ / on V esu or ct arm O ac L a t <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 /> Z �g(if appropriate) [:]SJ 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: OES <br /> PINK COPY: BUS. <br /> AUL ' ocA 4/0 <br />