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pQut>Y COUNTY OF SAN JOAQUIN <br /> aG OFFICE OF EMERGENCY SERVICES <br /> q ROOM 610, COURTHOUSE <br /> y s 222 EAST-WEBER AVENUE <br /> Cq._. �P • STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAM TELEPHONE NUMBER <br /> 7- A 6,�l/�� <br /> BUSINESS ADDRESS (Facility Being Inspec ed} s ZIP CODE <br /> tja <br /> FIRE DISTRICT INSP O DATE ARRI AL 'IME DEPARTURE TIMEIL <br /> ORNAME/AGENCY <br /> o0900 /0,so <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1. Business 1 MMP Complete and Accurate 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate F 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate 8. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> / 10.Conditions noted that could increase risk of releas <br /> 5.Training/Exercise Records Available �f/ or hinder irn lementation of erner enc lan <br /> EXPL_ILNATION OF FINDINGS AND COMMENTS <br /> 1 j r <br /> L� I <br /> '7 / W e. 0 A,-eo. <br /> 74 C Cwt fry t <br /> r -14 'fit <br /> cLC_��yt l Qt v� t.J i f1 c�. 7�c x._17 <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) SJ Ag SJ Env Hlth ROSHA Fire Air Dist <br /> r v-„4 AV— 7/ Z 0 ..t <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business epreTe <br /> iv (Print Name and Title) Business Rep esentativ Si ature) i <br /> WHITE COPY: OHS <br /> c/_— PINK CQPY: BUS. <br /> 4107 <br /> w <br />