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ppurp COUNTY OF SAN,JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />X ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE Z 7 9 7 <br />STOCKTON, CA 95202-2709 <br />Cq�rFORa�P BUS. (209) 468-3969 FAX (209) 468-0273 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS N ME <br />%4T ,'!J <br />7- Mob <br />TELEPHONE NIER <br />MB <br />VZ.j-S pLj_ Vf 102 <br />BUSINESS ADDRESS Facility Being I spected) <br />3333 : C",i-' ci.ol. oc o <br />ZIPCODE <br />g�5_2_ 0 <br />FIRE DIISTRICT'' 1 <br />INSP O DATE <br />0 <br />A VAL TME <br />2 - <br />DEPARTURE TIME <br />INSPECTOR NAM/E!AGENCY <br />DOCUMENT REVIEW YES NO FACILITY WALK THROU H YES NO <br />DOCUMENT <br />1. Business HMMP Complete and Accurate <br />6. Facility Map Complete and Accurate <br />2. Chemical Description Pages Complete and Accurate <br />t/' <br />7. Chemical Inventory Complete and Accurate <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 />5. Training/Exercise Records Available <br />/� <br />10. Conditions noted that could increase risk of release <br />or hinder implementation of emergency lan <br />EXPLANATION OF FINDINGS AND COMMENTS <br />i' O — a' <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 />/7 GF/r,� <br />Follow -Up Inspection Date <br />(if appropriate) <br />Referral Actions <br />❑ SJ Ag ❑ SJ Env Hlth OSHA [:]Fire ❑ Air Dist <br />❑ <br />)URNOWLEDGEMEENT OF REVIEW AND <br />RECEIPT OF INSPECTION RE§ULTS <br />t Name and Title) <br />BusiM7AIM <br />® <br />Business Rep sentative (' ) <br />PINK COPY: BUS. <br />4107 <br />