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COUNTY OF SAN JOAQUI <br /> �44R •cpc OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> ..a4. STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> �y!i�/irfTi9/•l/ f'/O4"S415r CSD Gel%vT 7 P J f 32-So6/ <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL <br /> TIME DEPARTURE TIME INSPECTOR NAMEIAGENCYY /ij� <br /> 72wo_' z a00/a� 0'77.KTI �/49 ov // �6�C61 w <br /> DOCUMENT REVIEW YES W FACILITY WALK THROUGH YES O <br /> 1.Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate 7. Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate 8. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled A/107 <br /> 10.Conditions noted that could increase risk of releas <br /> 5.Training/Exercise Records Available <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> 9. ,rs�itiBrt O/t>S .�/0 7'fa✓.vvoCE f✓.02�.BOo�i� G✓.vs1` <br /> gm:r <br /> /,t/6SS Ae CGEwly A/YG1/iry <br /> 76lyyDLDG Til4yT�D66S /w9.eer�l//.C8 uT6Ly' /+�i1'�•9i�00� Tcitird <br /> i.✓ a'fyd�/lOC6.�S. <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 Follow-Up Inspection Date Referral Actions <br /> (if appropriate) SJ Ag [—]SJ Env Hlth OSHA Fire ❑ Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> X TohN m�//E <br /> e SE/yJeQ 0 P-ps I� PINK COPY: BUS. <br />