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Pa�,N COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE #/ Z i oc>�� <br />STOCKTON, CA 95202-2709 <br />��FOR BUS. (209) 468-3969 FAX (209) 468-0273 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME <br />k T * 6' <br />TELEPHONE NUMBER <br />-z- <br />BUSINESS ADDRESS (Facili eing Ins cted) <br />z �s Ce -1 o..� ;c. 4 .,� . �� y <br />ZIP CODE <br />9_S3o C/ <br />FIRE DISTRICT <br />Tr'2r, <br />INSPECTION DATE <br />8/Glop" <br />ARKIVALTIME <br />101,5-' <br />DEPARTURE TIME <br />/0,70 <br />I INSPECTOR NAMEIAGENCY <br />A4, -/- Lys-2�0� <br />DOCUMENT REVIEW YES NO FACII.ITY 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 />7. Chemical Inventory Complete and Accurate <br />3. Business Identification Page Complete and Accurate <br />✓ <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 />%Y <br />10. Conditions noted that could increase risk of release <br />or hinder implementation of emergency lan <br />t <br />EXPLANATION OF FINDINGS AND COMMENTS <br />T,` e_ t1-N'1_e_ .9_1 O / rs <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 />_=CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative (Print Name and Title) <br />R,U'L, <br />q'l7l ltd' �e Ct1 C <br />Business Representative (Signature) <br />WHITE COPY: OES <br />PINK COPY: BUS. <br />4/07 <br />