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aP�u�N COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ' 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> -_ Telephone:(209)953-6200 <br /> �'•. :P Fax:(209)953-6268 <br /> gticoaN <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> XVL &VrZfX_ E_'0_Ta'JAJ 17701 Vm D' sh9Nrcx 2 . S—Z/O <br /> ACCOUNT# START DATE(New Bus) INSPECTION ATE JARRIVALTIME DEPARTURE TIME INSPECTOR NAME <br /> �l]G� io z� v9I p9o0 <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 r&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 /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTIO ESUL <br /> usineRg <br /> ss presentative(Print Name and Title) Busin s Repr en 've(Si re) <br /> oi� _ WHITE COPY: OES <br /> PINK COPY: BUSINESS <br />