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COUNTY OF SAN JOAQUIN <br /> p4Ut"' T OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE ! 0 G <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME II TELEPHONE NUMBER <br /> _5+ 5 c. L �to� � st� S 2-042- 4`F Gi2 <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> Z)S7 5 r . (_ uU'�c,t' S-�. 044 k `IS26 <br /> FIRE DISTRICT/ I INSPECCIONDATE RRIVALTTME DEPARTURETPAE INSPECTORNAMFJAGENCY <br /> S <br /> 4-0 , 7 /7 O / 3_ o /& /b ke Q Ce ` <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <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 <br /> 10.Conditions noted that could increase risk of releas <br /> 5.Training/Exercise Records Available `� or hinder implementation of e ergency 1lan <br /> EXPLANATION OF FINDINGS AND COMMnnENTS <br /> o T' <br /> /�'�2. v�1M+ GS o-w�"dS �' �a.7 �-c.v�c,S <br /> (/I /,eS <br /> d a_ /�/K�c K/7 4.- o !4w Or/ A -G <br /> S O d4 e / �O� E. C h Gr <br /> LL iLiIAf Q /t44 ` <br /> r. s not erre cf <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 /> J2 ZD O (if appropriate) SJ Ag [—]SJ Env Hlth OSHA ❑Fire Air Dist <br /> w ❑ <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Represent ve(Print Name and Title) Business Representative(Signature)s <br /> ITB COPY: OBS <br /> PINK COPY: BUS. <br /> 4107 <br />