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PquiN COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES ,//; <br /> ' 2101 E. Earhart Avenue, Suite 300 'll 324) <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> c p Fax:(209)953-6268 <br /> 'rci c hYix' <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> Ba INES AME // ADDRESS(Facility Being Inspected) <br /> SSD �- ✓�. 2b <br /> ACC�O}NT# START DATE ew Bus) INSPECTION ATE I ARRIVAL TIME IDEPARTUIRE TIME JINSPEQTOR NA / <br /> 20 16 1 112- 71 6 1 0 / 6 0 <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 Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training 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 1 <br /> r�I "Ido/S O �' cJ 7 p- 0 / , / <br /> ZX 2- (Po d `teuJ p <br /> o,ti X, - -e_ '. rv-L r n l� k� i n �lnn za ct 4.39 - 0 9'f Sz <br /> in Lek Au6 i .� LvcL . — lbd Q <br /> i . <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> _ wBrt7=coev: oes <br /> INK COPY: BUSINESS 4, A <br /> -MLIM <br />