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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> a' 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Sd hey -O(.z <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> I � 3g vJ d 6.6 <br /> FIRE DI TRICT INSPECTION DATE JARRIVALTIME DEPARTURE TI INSPECTOR NAIv�E/AGENCY <br /> -y a ►mac <br /> OCUMEI, REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate 'r <br /> 2.Chemical Description Pages Complete and Accurate 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate S. Employees Familiar with HMMP 1� <br /> 4. HMMP/Map Easily Accessible to Employees Y' 9.Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Available y 10.Conditions noted that could increase risk of releas y <br /> O or hinder implementation of emergency lan O <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> 14 C, eLp <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 /> fi (if appropriate) 0 SJ Ag ❑SJ Env Hlth ❑OSHA 0 Fire ❑ Air Dist <br /> ❑ <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and usiness Representative(Signature) <br /> WHITE COPY: OES <br /> PINK COPY: BUS. <br /> 6_7 401 A <br /> 4 07 <br />