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COUNTY OF SAN JOAQUIN <br /> PQM N OFFICE OF EMERGENCY SERVICES <br /> ? ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-39690(209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> iCo .9&-7—(-- z 209- S/77- o coo k <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> / E Z,/, S;z�t-�c7a^l 9Sz/ 2 <br /> FIREDISTRICT INSPECTIONDATE ARRIVALTIME DEPARTURETIME INSPECTORNAMEEJAGENCY <br /> 22_ 1 7-2s--07 /Q ' ,t y lj6weu /y,c Le-w oG-3' <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 Available0.Conditions noted that could increase risk of release <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> NOTE: All IIMMP 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 /> 7 (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) Busine�esen[ iv (Signature) <br /> WHITE COPY: OES <br /> Mai �� PINK COPY: BUS. <br /> !,,`/tI <br /> 4/07 <br />