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COUNTY OF SAN JOAQUIN <br />Pqurry <br />OFFICE OF EMERGENCY SERVICES <br />r' s ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE A&/Z ,Fd P <br />STOCKTON, 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 />ATE -r Nakkl <br />800 _ 63I'.-2�'z2 <br />BUSINESS ADDRESS (Facility Bein Inspected)//-- <br />ZIPCODE <br />9S33ro <br />_2 u i- / au fiz C- <br />FIRE DISTRICT <br />INSP ON ATE <br />ARRI AL TIME <br />DEPARTURE TIME <br />INSPECTOR NAMFJAAGENCY <br />10a,t ke-c cL <br />e GlP <br />���� <br />113 <br />/eG er � Lc e Z 0lis <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP Complete and Accurate <br />r/ <br />6. Facility Map Complete and Accurate <br />2. Chemical Description Pages Complete and Accurate <br />✓ <br />7. Chemical Inventory Complete and Accurate <br />v <br />3. Business Identification Page Complete and Accurate <br />8. Employees Familiar with HMMP <br />4. HMMP/Map Easily Accessible to Employees <br />9. Hazardous Materials/Waste Properly Labelled <br />v <br />5. Training/Exercise Records Available <br />10. Conditions noted that could increase risk of release <br />or hinder implementation of emergency lan <br />EXPLANATION OF FINDINGS AND COMMENTS <br />/ <br />l �l' y T�I-� fjl:. N-. !�/fC�i'.rT io..� e i�N .Of/la'✓1 W AO <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 <br />Follow -Up Inspection Date <br />Referral Actions <br />(if appropriate) <br />❑ SJ Ag [:]SJ Env Hlth [:]OSHA—]Fire [:]Air Dist <br />❑ <br />.;KN EDGEMENT OF VIEW AND <br />RECEIPT OF INSPECTION RESULTS <br />Business Representative (Print Name and Title) <br />Business Representative (Signature) <br />WHITE COPY: OES <br />/Q,�) "' _ <br />AUL �j V t 1� i�i� I eC (� 0 t C %0 <br />PAUL <br />PINK COPY: BUS. <br />4/07 <br />