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IP <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS N !/�/ ADDRESS(Facili Be' nspect ) <br /> s L/L �l <br /> ACCpO.UNI # START DATE(New Bus) INSPE//CTI�N/D TE ARRIIVALTIME DEPARTURE TIME INS/�PE�j �M�/ <br /> 7 Z9/ tp 4 1 9 LZ�V /cob?r1 Co <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible t/ 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate v 7. Presence of Non-Listed Regulated Chelof <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 L <br /> 5.Training Records Available 10. Conditions that would hinder implemeEmergency Plan or increase risk of rel <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> No CO. r mad <br /> I <br /> NSPECTIONLLOW UP INFORMATION <br /> ns Additional <br /> By: Referrals/Notes: <br /> EMENT OF REVIEW AND RECEIPT OF INSPECTION RESntative(Print Name nd Ti[ Bu epre en n <br /> A. V„��,N1 / WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> REV twos <br />