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COUNTY OF SAN JOAQUIN <br />r9t,OFFICE OF EMERGENCY SERVICES <br />cui�oft <br />ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUESTOCKTON, <br />CA 95202-2709 <br />BUS. (209) 468-3969 FAX (209) 468-0273 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME <br />TELEPHONE NUMBER <br />/ / <br />��� -20 -4�z0� <br />o `i-1` <br />BUSINESS ADDRESS (Facility Being I spected) <br />ZIP CODE <br />qls� 5' • , . o.� G✓a �� c:� C_ H CQ .� <br />4S2 3! <br />FIRE DISTRICT <br />WSPECTIO 'DATE <br />A I AL TINIE <br />J7��- <br />DEPARTURE TIME INSPECTOR NA AGENCY <br />o <br />095 a <br />!o �e C/ e-1 o <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP Complete and Accurate <br />6. Facility Map Complete and Accurate <br />2. Chemical Description Pages Complete and Accurate <br />C, -o' <br />7. Chemical Inventory Complete and Accurate <br />' <br />3. Business Identification Page Complete and Accurate <br />u--*� <br />8. Employees Familiar with HMMP <br />4. HMMP/Map Easily Accessible to Employees <br />✓ <br />9. Hazardous Materials/Waste Properly Labelled <br />S. Training/Exercise Records Available <br />10. Conditions noted that could increase risk of release <br />or hinder implementation of emergency lan <br />EIXLPLANATION OF FIN�D�INGS AND COMMENTS <br />4, <br />e, i e 1 L 111-111-01 it o. n ��}c� ter^ L.la�' S <br />�# 2- -- mad a.^ a ✓; 1�, ��,`a �, s,� r�o -- <br />ea <br />r / <br />'e- <br />alCy Q' c C. LIL V at � lr_ . <br />f�� <br />QLA <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 pass«ord. <br />INSPECTION FOLLOW-UP INFORMATION <br />Corrective Actions Must Be Submitted By <br />Follow -Up Inspection Date <br />Referral Actions <br />(if appropriate) <br />�SJ Ag E] SJ Env Hlth OSHA [:]Fire Air Dist <br />TCA$i �-O b $' <br />1./ <br />El <br />LEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />epresentative (Print Name and Title) <br />urines to (Signature) <br />t <br />M1r1C'\C_k&Wuu� G_r'jkC'A <br />^1 \ <br />WHITE COPY: OES <br />PINK COPY: BUS. <br />4/07 <br />_t�> <br />Ij I <br />