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0Pp,uiry COUNTY OF SAN JOAQUIN <br /> OFFICE F EMERGENCY SERVICES <br /> Q Z� 2101 E. Earhart Avenue,Suite 300 <br /> Stc ckton,California 95206 <br /> Telephone:(209)953-6200 <br /> Fax:(209)953-6268 <br /> A<i p CRN <br /> HAZARDOUS MAT RRIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME 1/ RLv`"t ADDRESS(Facility Being Inspected) <br /> CheACCOUNT# START DATE(New Bus) INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTOR NAME <br /> rla6 � �-G-ri l a r <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 ff 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: Referral's/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business presentative(Print Name and Title) B mess Repr mat' a(Signature) <br /> WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> REV 11108 <br />