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a�ln b/ COUNTY OF SAN JOAQUIN <br /> �o. .coG OFFICE OF EMERGENCY SERVICES <br /> r` 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> Fax: (209)953-6268 95-2-0 (. <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> AjIAo c-; • ovc. S <br /> ACCOUNT k START DATE(New us) INSP 10 DATE ARRIVAL TIME DEPARTURE TIME jINsptcTOR NA E <br /> OZ P6 / /40,dr <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <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 <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate V 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 0. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> + <br /> �o�— PAaVic{ e. ✓cioT 010 <br /> P�Wr to e ia .n i.i <br /> ge- <br /> 2.0 ✓ O. � �. fnje C <br /> rNSPECTION FOLLOW UP INFORMATION <br /> e Actions Additional <br /> bmitted By: �I.t.I Z�pCI Referrals/Notes: <br /> LEDGEMENT OF VIEW AND RECEIPT OF INSPECTION RESULTS <br /> Repr sentative(Print Name andTitle) Bus ess Representative(Signature) <br /> _ WHITE COPY: OES <br /> a 1 h <br /> 041D PINK COPY: BUSINESS <br /> REV 12/08 <br />