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VW COUNTY OF SAN JOAQUIN' <br />atqulN oo OFFICE OF EMERGENCY SERVICES <br />Q: ? 2101 E. Earhart Avenue, Suite 300 <br />�; • " Stockton, California 95206 Zo-,3 2 3 - 3 S <br />• • Telephone: (209) 953-6200 <br />�..•• ;P Fax: (209) 953-6268 p �r 7 ^ <br />.._ <br />4�l (J c—lJ <br />6... <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME ADDRESS Facility Being Inspected) <br />ACC•Oy�NT # START DATE (New Bus) INSP CCI NDA RRIVAL TIME DE ARTU ETIME INSP CTOR N M <br />/ 5 /�ov e�E// <br />Lo R - <br />^'2 (J J t�-VN L ZOOS 3 /O 4 9 /SD0 <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />. 1. HMMP/Map On Hand and Easily Accessible <br />6. Facility Map Complete and Accurate <br />2. Business Identification Page Complete & curate <br />7. Presence of Non-Listed Regulated Chemicals <br />3. Business HMMP Complete and Ac ate. <br />8. Employees Familiar with HMMP <br />4. Chemical Description Pag Complete and Accurate <br />9. Hazardous Materials/Waste Properly Labelled <br />10. Conditions that would hinder implementation of <br />5. Training Records Available <br />Emergency Plan or increase risk of release are absent <br />EXPLANATION OF FINDIN SSAND COMMENTS <br />til <br />0 x a G O t4 X" <br />�,< Cr <br />I <br />XSs I O, t (T ✓ V, u-S 0, S e LJ Jam' ✓ I <br />orCk its {/ <br />O I _R_ <br />Q 2 2— <br />POJ <br />PI f L.1 <br />2 <br />+ x C(Iovk ftA.Nv o cL.A_s--c- �e � <br />lloKp14Pt S),0 <br />zX Jf- <br />s k.40,- 0. <br />Z -7 S l l k SS o <br />GatesCe. <br />HARDWARE & SUPPLY <br />A RELIABLE COMPANY <br />Alan Aavedal <br />Manager Northern California Division <br />3748 Zephyr Ct. • Stockton, CA 95206 <br />Office: (209) 323-3840 . • (888) YO-GATESCO <br />INSPECTION FOLLOW UP INFORMATION Fax: (209) 982-9503 • Cell: (909) 578-1607 <br />orrective Actions Additional alan.aavedal@rwli.net <br />o Be Submitted By: Referrals/Notes: <br />CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business RepresentativePrint Name and Title) Business ntative (S Lure) <br />( WHITE COPY: OESUS <br />PINK COPY: BUSINESS <br />I REV 17108 <br />