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Ak <br /> p'. COUNTY OF SAN JOAQUIN <br /> �o. .co` OFFICE OF EMERGENCY SERVICES <br /> a' 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> FOR�s' Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> KW M (1395- /ero2r ac— Alc. SJ,eS <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE I ARRIVAL TIME DEPARTURE TIME INSPECTOR NAME <br /> /3 70 —" 13- 17 -05, �Stzo SIS-Len/ <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 <br /> _�r_c`F�ta Opc�(CL� lu r-A / f'j Z� OA_C P1 t'L`^a <br /> INSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> To Be Submitted By: R kiRels/Notes: '�P6 'JrPT, f8or— '/,ono ir ^'t Brno? e pgoo <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Busin ss Re resentative(Si azure) <br /> WHITE COPY: OES <br /> I�C� l G rly� AI - PINK COPY: BUSINESS <br /> REV 17J08 <br />