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aRayty COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> c' 2101 E. Earhart Avenue, Suite 300 <br /> a: < <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> '�tFO'RH�P Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS MME ADDRESS(Facil'ty Being I peeled) , 1 <br /> CC UNT# START DATE(New Bus) NSPECTION DATE ARRIVAL TIME DEPART RE TIME IN E R AN�) <br /> A X5 <br /> / INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 7. Presence of Non-Listed Regulated 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 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> ustness eprese uve(Print Name and rt/l7-e)�� Business Repre ntanve(Sign ure <br /> 7W l WHITE COPY: US <br /> l/{!L// r/ PINK COPY: BUSINESS <br /> AIAREV 12)08 <br />