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arQ�!H. COUNTY OF SAN JOAQUIN <br /> s.• a',o <br /> _:• •:= OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> • �, " Telephone: (209)953-6200 <br /> ,�rFGRN�' Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE ARRIVAL TIME DEPARTURE TIME JiNSPECFOR NAME <br /> ,.2 13 Phio !�i <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> I.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 1 7. Presence of NonListedRegulated Chemicals <br /> 3. Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 4 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS ./ <br /> � � d" e vt•S c <br /> NSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional / <br /> 9e Submitted B=usinestRepresentative <br /> : Referrals/Notes: <br /> T OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> (Print Name and Trt e) Business Representative(Signature) <br /> ITE COPY: OES <br /> JAL nl.QJ� PINKCOPY: BUSINES <br /> aev twos <br />