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1 <br /> 0 <br /> 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 /> Fax:(209)953-6268 <br /> '/[ikcaN <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) "'/ <br /> Z4�y r2ms LCG V., <br /> //// , Pt/ d;WP - SAP4 6.r/ fs_204!� <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE I ARRIVAL TIME IDEPARTURE TIME INSPECTOR NAME <br /> 92-5 / o/a /D D x'20 1 <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YESpfo FACILITY WALK THROUGH YES O <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals 5E6 <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate S66 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 /> 61/ <br /> g�vi�,►G /d/UdvT�y�� uL7 �'�.v .ts-d.� <br /> 61'l .� rrya L✓, GL a6 iF�rd.,,o�ca-,�..� Gy'/� d 6t LoC.r�/r.., �1' <br /> 66 o <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: 64S Referrals/Notes:/f/Oly-r <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) I Business Representative(Signature) <br /> WHITE COPY: OES <br /> AI, PINK COPY: BUSINESS <br /> REV 17106 <br />