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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> y' <br /> 222 ROOM SCOURTHOUSE <br /> T WEBER AVENUE / 7 F6 <br /> \6 <br /> STOCKTON, CA 95202-2709 <br /> CRLiFOaa`P <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> A <br /> Ix 7 a� <br /> B SINESS ADDR (Facility Being Inspected) ZIP CODE <br /> FIRE DISTRACT /SPE ON ATE ARRIVAL TI DEPART URE TIME INSPECTOR NAMEIAGENCY <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROU H YES NO <br /> 1.Business HMMP Complete and Accurate Cr 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate v 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate v 8.Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 10.Conditions noted that could increase risk of release 5.Training/Exercise Records Available or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> Q J <br /> i!bv -e—- _ 4 U 4 <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 Dare Referral Actions <br /> (if appropriate) ❑SJ Ag ❑SJ Env Hlth ROSHA [:]Fire ❑ Air Dist <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> PINK COPY: X07 <br /> (� ly <br />