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Pqu,. COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a` 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> ••c .;L �P• Fax:(209)953-6268 <br /> ,�/FGPN HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) ,/ p <br /> U Z/O 5"2--r3 �iP /j—>G FfYE /S�ZO f <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INS,PfECTOR NAME <br /> Zo© 9 - G -O9 /m 5b <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,C e&Accurate 7. Presence of Non-Listed ated Chemicals <br /> k5Traii'ininsg <br /> usnes HMM mplete and Accurate 8. Employ miliar with HMMP <br /> al Description Pages Complete and Accurate azardous Materials/Waste Properly Labelled <br /> 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 /> G©z -`Pp.209.474.9900 <br /> 5633 Pacific Ave. <br /> Stockton,CA 95207 <br /> f. .,: <br /> Denny Seki Jr. <br /> General manager <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) WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> xsv tv <br />