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i <br />Pp U1N COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />r. z 2101 E. Earhart Avenue, Suite 300 <br />Stockton, California 95206 <br />-._ Telephone: (209) 953-6200 <br />�°'•• Fax: (209) 953-6268 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />B ESS NAMFA <br />V <br />Faciliteing spected R <br />ccw <br />S A DATENew Bus) 0TEARRVALTMEDEPARTUETI <br />U <br />IN E OR AM <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. HMMP/Map On Hand and Easily Accessible <br />6. Facility Map Complete and Accurate <br />2. Business Identification Page Com & Accurate <br />7. Presence of Non -Listed Regulated C call <br />3. Business HMMP Compl and Accurate <br />8. Employees Familiar wit MP <br />4. Chemical De pion Pages Complete and Accurate <br />9. Hazardous M ials/Waste Properly Labelled <br />5. T ' mg Records Available <br />10. CoudKons that would hinder implementation of <br />mergency Plan or increase risk of release are absent <br />EXPLANATION OF FINDINGS AND COMMENTS <br />e7 0 r' <br />newlu _. __ .._. _... <br />o • (' �\ 1 <br />INSPECTION FOLLOW UP INFORMATION ' <br />CCorrective Actions <br />o Be Submitted By: <br />Additional <br />Referrals/Notes: <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative (Print Name and Title) Business Representative (Signature) <br />A -)K ,�•� s <br />WHITE COPY: <br />PINK COPY: BUSINESS <br />REV 12108 <br />