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Po �N UIN <br /> COUNTY OF SAN JOAQ <br /> �q• .�fl` OFFICE OF EMERGENCY SERVICES <br /> z 2101 E. Earhart Avenue, Suite 300 <br /> Stockton, California 95206 <br /> Telephone: (209)953-6200 i <br /> • c-.. �P• Fax:(209)953-6268 <br /> � R�IFpR� <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> AA��-rte T'c.ir.I C VAP St-,ro P t I 7 73 d �c-0.1 <br /> ACCOUNT# START DAJE(New Bus) INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTOR NAME <br /> —j? -4> F I /14CTO I Alt—d—f=F-w <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> ~ 2:Business Identification Page Comple ccurate 7. Presence of Non-Listed ated Chemicals <br />` 3.Business HMMP Compl nd Accurate 8. Empl,_yec5familia,with HMMP <br /> 4,Chemical D 1ption Pages Complete and Accurate Hazardous Materials/Waste Properly Labelled <br /> S. Hing Records Available 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> C I-i S ©.A/ s 9-tF- = <br /> • %Pe+4f*,1SM(JS' ioP4 ,CL-CAl.V <br /> ATE3 R— d 1 t_ �Z�L7 [O l ) <br /> �[ &A L_ <br /> 111 Te- A-N Tn t� z_ -�--- <br /> A-� Tt:5- 8 t t.... <br /> A/&7E-- - H-f- ,0-00-4 QuA'-t r-e rrzoj"/3 st+o Ps <br /> A4�o+,1 c - z 0 9 - y 7 3 - <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> o Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RES <br /> Business Representative (Print Name and Title) Business Re ntat e( ign re) <br /> WHITE COPY: OES <br /> C PINK COPY: BUSINESS <br /> RFV 12108 <br /> 1 <br /> G <br />