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na'1�H- COUNTY OF SAN JOAQUIN Oy��/ <br /> OFFICE OF EMERGENCY SERVICES <br /> r. Z 2101 E. Earhart Avenue,Suite 300 7/3 <br /> a: .t <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> Ca[i Fi;'pN�' Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME I ADDRESS(Facility Being Inspected) <br /> rs :�!) 5 S 40909 / O' x 7r-$ Sz/o <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATEARRIVAL TIME DEPARTURE TIME INSPECTOR NAME <br /> a8 -z - o9 //.rte <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 ccumte 7. Presence of Non-Listed Regul emicals <br /> 3.Business HMMP Compl d Accurate 8. Employees Fa with HMMP <br /> 4.Chemical ption Pages Complete and Accurate 9. rdous Materials/Waste Properly Labelled <br /> 5. raining 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 /> C.2fG'M S en/ - <br /> /�cE <br /> Ox Y l —s? /Zs— G z 7S vc <br /> &O'l <br /> -111--6-41C G!fLl <br /> i <br /> Co GALL o ,j,� <br /> Electric Gate Ornamental Iron <br /> Systems Fencing <br /> �✓�/�K — STE�/En/ /1�o WES DAY <br /> GATE SYSTEMS <br /> hAv^ld 2-9>`/ - S/ - Steven "Vango" Norris <br /> Executive Vice President <br /> L f�JJ .435 - 6909 Tam O'Shanter <br /> Stockton,CA 95210 (209)951-4445 <br /> License No.920353 <br /> LINSPECTI'ON FOLLOW UP INFORMATION <br /> Actions Additional <br /> mitted By: Referrals/Notes: <br /> LEDGEMENT OF REVIEW AND RECEIPT OF INSPECTIO RESULTS <br /> epresentative(Print Name and Title) Buslnegs epresentative( ignature) <br /> t, WHITE COPY: OFS <br /> L. .�nrFls s( rLQ . LLL I PINK COPY: BUSINESS <br /> REV 17/08 <br />