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COUNTY OF SAN JOAQU& <br /> '4H1N <br /> aOFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> a .. STOCKTON, CA 95202-2709 <br /> "O"" BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> A003Sa - l/AtL-F_Y r-t9RXLIFT 93J- 0z06o <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 13 M—i -r ft c w--T-o N * lzr-z o - <br /> FIRE DISTRICT INSPECTION DATE I ARRIVAL TIME DEPARTURE TAME INSPECTOR NAME/AGENCY <br /> 2-7 el- lt-0 /OS-z A-L-e-A/ /OeS <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 /> 5.Training/Exercise Records Available 10.Conditions noted that could increase risk of releas <br /> or hinder implementation of erItl rgency plan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> /«'L J ©wl <br /> A41; ��d- Cxnt xYC,-� - 2SFr�c -5 �$� Frs <br /> ©/L - 70 cam- �G T-''��-��I�' j r 0 IC9-3 S -Z!s 1,-P 7 <br /> fISYE /4/Tl 6eEZ57 ZC - <br /> /0-'0 G r+�- <br /> iITTri /br.. <br /> 2 P - / eo eM 1,jVeW rVA-V To s e4 *SO(/C7 ., <br /> S - �zbyelE gnoP /-' G- <br /> >fi� - a^4-r- AfAers <br /> va �✓ - GpC,�i'fonl Br' cNcMS - <br /> - Q[ o Aye - AM7- 1 L/A-r - AA/7w &A-nl OR- Ladle LQGFT l0AL <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 /> 06K (if appropriate) E]SJ Ag []SJ Env Hlth OSHA [:]Fire ❑ Air Dist <br /> E] <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Busm s Representative(Print Name and Title) I cc— Business Representative(Signature) <br /> WHITE COPY: OES <br /> 068- PINK COPY: BUS. <br /> 4/07 <br />