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>auly woCOUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a: .w <br /> 2101 E. Earhart Avenue,Suite 300 <br /> ` Stockton,California 95206 <br /> - Telephone:(209)953-6200 <br /> c4YI o"a"cP Fac:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME J ADDRESS(Facility Being Inspected)'rf 'ry, <br /> GtC vie C l�._o.� 1--2- 775— �Td Iv - 1 /C? C <br /> ACCOUNT# START DATE(New Bus) INSPECHONDATE JARRIVALTIME DEPARTU ETIME INSP ORNA <br /> 1336 FG- ay I P_ t57 l2 <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> . 1.HMMP/Map On Hand and Easily Accessible . 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 /> ►�pPei <br /> 6 wt� off--*� �z <br /> Le, 12 <br /> �� h� ►n n <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: VVf Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> 1 <br /> \ T /C A I , � \) PINK COPY: BUSINESS <br /> J v REV 12/081 <br />