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COUNTY OF SAN JOAQUIN <br />�PQut" . OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE <br />STOCKTON, CA 95202-2709 <br />BUS. (209) 468-3969 FAX (209) 468-0273 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />B S ES NAME /��� TELEPHONE NUMBER <br />dr/ <br />�O <br />AV. <br />BUSIN S ADDRESS (Facility eing Inspected) ZIP CODE <br />FIRE IS COT INS ONDATE ARRIVALTIME EPARTURETIME SP TO NA AGE�O <br />DOC NT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP Complete and Accurate <br />6. Facility Map Complete and Accurate <br />2. Chemical Description Pages Complete and Accurate <br />7. Chemical Inventory Complete and Accurate <br />3. Business Identification Page Complete and Accurate <br />8. Employees Familiar with HMMP <br />4. HMMP/Map Easily Accessible to Employees <br />9. Hazardous Materials/Waste Properly Labelled <br />5. Training/Exercise Records Available <br />10. Conditions noted that could increase risk of releas <br />or hinder implementation of em rgency plan <br />EXPLANATION OF FINDINGS AND COMMENTS <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 <br />(if appropriate) <br />Referral Actions <br />❑ SJ Ag ❑ SJ Env Hlth ❑OSHA F]Fire ❑Air Dist <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION <br />RESULTS <br />Business Representative (Print Name and Tide) Business Representative (Signature) <br />WHITE COPY: OES <br />PINK COPY: BUS. <br />4/07 <br />