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L/ COUNTY OF SAN JOAQUIN <br />♦Ru!ry <br />OFFICE OF EMERGENCY SERVICES <br />2101 E. Earhart Avenue, Suite 300 <br />Stockton, California 95206 <br />-_-_ Telephone: (209) 953-6200 <br />• C ., �� • Fax: (209) 953-6268 <br />otic°sN HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSIN S NAME <br />AD � ESS (Facility Bein Inspected) <br />M. 901 <br />ACCOUNT N START DATE (New Bus) <br />INP ION DATE <br />1, -Z -0 <br />ARRIVAL TIME DEPART E ME <br />IN <br />PE OR AM <br />ccs <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH <br />YES NO <br />1. HMMP/Map On Hand and Easily Accessible <br />6. Facility Map Complete and Accurate <br />X <br />2. Business Identification Page Complete & Accurate <br />7. Presence of Non -Listed Regulated Chemicals <br />X <br />3. Business HMMP Complete and Accurate <br />8. Employees Familiar with HMMP <br />4. Chemical Description Pages Complete and Accurate <br />9. Hazardous Materials/Waste Properly Labelled <br />5. Training Records Available <br />10. Conditions that would hinder implementation of <br />Emergency Plan or increase risk of release are absent <br />EXPLANATION OF FINDINGS AND COMMENTS <br />dry o(_ ugsh - 91Al <br />. c C461 d i <br />' <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions <br />To Be Submitted By:Uqu Sl <br />Additional <br />Referrals/Notes: <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative (Print Name and Title) u 'ness Representati a Signature) <br />1. I Ilx—J <br />WHITE COPY: <br />PINK COPY: <br />OES <br />BUSINESS <br />REV I <br />