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COUNTY OF SAN JOAQUIN <br /> a"RUt"' OFFICE OF EMERGENCY SERVICES <br /> a ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> °gYrFo �`*r STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS S NAME TELEPHONE NUMBER <br /> L <br /> BUSIN SSRESS(Facility Bing Inspe ted) ZIP CODE <br /> FIRE DISTRICT I INSPECTION DA ARRIVALTIME IDEPARTURETIME JINSPFCTORNAMEIAG CY <br /> V <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete a ccurate 7.Chemical Inventory Complete and A <br /> 3.Business Identification Pa mplete and Accurate 8. Employees Familiar W>tHT3kP <br /> 4. HMMP/Map y Accessible to Employees 9.Hazardous als/Waste Properly Labelled <br /> rltg/Exercise Records Available 10.C ons noted that could increase risk of releas <br /> 5 Tor hinder implementation of ern enc Ian <br /> Ph <br /> EXP�LQANNAATION OF FINDINGS AND COMMENTS <br /> - mepic <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 Date Referral Actions <br /> (if appropriate) E]SJ Ag ❑SJ Env Hlth [_]OSHA —]Fire ❑ Air Dist <br /> 11 <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> � y- <br /> 1), <br /> WHITE COPY: OES <br /> lnlllll¢KkitL7C(e1/4�� S'/F6 y Uf/?, D PINK COPY: BU97 <br />