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apA�ly COUNTY OF SAN JOAQUIN <br /> ).•' '.O <br /> OFFICE OF EMERGENCY SERVICES <br /> Q. 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> "- Telephone:(209)953-6200 <br /> �4�IF pnpsP• Fax: (209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> EACCOUNT <br /> SINESS NAME ADDRESS(Facility Being Inspected) <br /> T l n / <br /> k START DATE(New Bus) INSPECTION DATE I ARRIVAL TIME DEPARTURE TIME I SPECTO NQ <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 /> Yk L ( NL 4ya G yi I,h <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions / Additional <br /> ro Be Submitted By: 2'- ^(/-1 Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Represen tv (Signature) <br /> KX�tD�Vi/1 WHITE OEs <br /> PINK COPY: <br /> BUSINESS <br /> REV tyn6 <br />