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o_= g COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a: 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> '�/FOPN`P <br /> Fax: (209)953-6268 <br /> BUSINESS NAME HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> ADDRESS(Facility Being Inspected) <br /> S <br /> ACCOUNT# ricTi v ' v 9dS y <br /> ART DATE New Bus INSPECTION DATE ARRIVAL TIME DEPARTURE TIM SP CTOR ME <br /> Y zi G y'�o <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES O <br /> 1,HMMP/Map On Hand and Easily Accessible FACILITY WALK THROUGH YES NO <br /> 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate <br /> 7. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate <br /> t� 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate <br /> 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> G��.o ,rte�ccrier��' ov.ev <br /> OCG4P.o...U6 Opt/ Tiy� E�'��T Slp� �„���,G G6 il'pl�6l7�9.�.c7 Tit�� <br /> 16 <br /> srQ�/'rO,Pij�iv✓ //iDGC�Lt �//GG d6 yplaFO <br /> NSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> o Be Submitted By: S/Z/lQ'q Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name an it a l3usmess a esentauv t ature) <br /> C 11 n ' WHITE COPY: OES <br /> yS Te;L G li eNA^e rt,(� k /0'"'5 PINK COPY: BUSINESS <br /> 2/08 <br />