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MW <br />Pou,N COUNTY OF SAN JOAQUI <br />OFFICE OF EMERGENCY SERV <br />ICES <br />r, ? 2101 E. Earhart Avenue, Suite 300 <br />P: -1 <br />Stockton, California 95206 <br />- J.Telephone: (209) 953-6200 <br />•c - _ <br />sP Fax: (209) 953-6268 <br />dt46i <br />HAZARDOUS MATERIALS PROGRAM INSPECTION <br />FORM <br />BUSINESS NAME <br />ADDRESS (Facility Being Inspected) <br />of kloell <br />oJ, S <br />oc_ <br />ACCOUNT # <br />START DATE (New Bus) <br />INSPECJION D RIVAL TIME <br />IDEPARTURE TIME <br />ID/,S— <br />JINSPECTOR NA <br />I Zd <br />210 2 1 o93o <br />L <br />if <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. HMMP/Map On Hand and Easily Accessible <br />acility Map Complete and Accurate <br />h/ <br />2. Business Identification Page Complete & Accurate <br />7. Presence of Non -Listed Regulated Chemicals <br />3. Business HMMP Complete and Accurate <br />8. Employees Familiar with HMMP <br />4. Chemical Description Pages Complete and Accurate <br />9. Hazardous Materials/Waste <br />Properly Labelled <br />Available <br />.Conditions [hat <br />Emergency Plan <br />ould hinder implementation of <br />r increase risk of release are absent <br />OF FINDINGS AND/JCOMMENTS/ <br />ffrds <br />—7 # G7' orry Gf / � <br />/2 4/' GIGO-� <br />fad t/ d 2. {2 <br />To <br />✓ I f___ <br />/d 2 �e_ Gt. i kc /ivt <br />/!xeillit l <br />�,15L /ad/-� <br />a -a: a. J <br />27�_ l! e �H <br />2 LQ- ✓ -� �c o <br />• GatesC*. <br />Ir HARDWARE & SUPPLY <br />' <br />A RELIABLE COMPANY <br />lQy cls 71 C� 23 cRb Alan Aavedal <br />Manager Northern California Division <br />C 3748 Zephyr Ct. • Stockton, CA 95206 <br />/ y Office: (209) 323-3840 • • (888) YO-GATESCO <br />INSPECTION FOLLOW UP INFORMATIO Fax: (209) 982-9503 • Cell: (909) 578-1607 <br />Corrective ActionsAdditional alan.aavedal@rwli.net <br />o Be Submitted By: Zoe Referrals/Notes: - <br />ACKNOWLEDGEMENT OF REVIEW A 'D RECEIPT OF INSPECTION RES <br />Business Representative Name and Title) Business resentative gnature) ITE COPY: OES <br />1(PPriilntt <br />`�\YP�Y 1�L G\`W`"� _ PINK COPY: BUSINESS <br />REV 12108 <br />