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Pa��N COUNTY OF SAN JOAQUIN <br />>� �o OFFICE OF EMERGENCY SERVICES <br />`a ROOM 610, COURTHOUSE <br />H. 222 EAST WEBER AVENUE /Z 7-7 7 <br />STOCKTON, CA 95202-2709 <br />BUS. (209) 468-3969 FAX (209) 468-0273 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSEVS1 NgkNIE � / <br />TELEPHONE NUMBER <br />X902 <br />BUSINESS ADDRESS (F ility Bein Ins cted) <br />ttT --- S c_ <br />ZIP CODE <br />9-f2 S <br />FIRE ISTRICT <br />1NSPEq(IONDA7f <br />414101 <br />ARRIVAL TIME <br />//o_ <br />IDEPARTURETIME <br />112-0 <br />INSPECTOR NAMOAGENCY <br />DOCUMENT REVIEW AXES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP Complete and Accurate WV0V�% <br />6. Facility Map Complete and Accurate <br />L <br />2. Chemical Description Pages Complete and Accurate L. — <br />7. Chemical Inventory Complete and Accurate <br />3. Business Identification Page Complete and Accurat <br />8. Employees Familiar with HIVIMP <br />4. HMMP/Map Easily Accessible to Employees <br />9. Hazardous Materials/Waste Properly Labelled <br />5. Training/Exercise Records Available <br />10. Conditions noted that could increase risk of releasel <br />or hinder implementation of emerge clan <br />L� <br />EXPLANATION OF FINDINGS AND COMMENTS <br />� 3 191 /0 ,o C-BOQ Lz- i r= ✓� -t row <br />_ <br />* II � Op <br />l II C-0 <br />b..� �14 T �� 1 @� '� i �A 0.S = aC � <br />c o 0 _� -� <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 />rrective Actions Must Be Submitted By <br />1720 <br />Follow -Up Inspection Date <br />(if appropriate) <br />Referral Actions <br />SJ Ag SJ Env Hlth OSHA Fire Air Dist <br />� <br />KNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RES TS <br />e and Title) <br />usiness Rep en tiv (P '7;c <br />UY Gt, � <br />Business Re esentative t n re) <br />WHI COPY: : BUS <br />PINK COPY: BUS. <br />4/07 <br />