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cE4uly, COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> -' Telephone:(209)953-6200 <br /> �4• �P <br /> FFax: (209)953-6268 <br /> �iORN <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINES NAME ADDRESS(Facility Being Inspected) <br /> rlLL �, �d Cortin d <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE I ARRIVAL TIME IDEPARTURVTIME INSP CfOR NAME <br /> l�l(o q- -tp Cl9 [C/3b at-a <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible ,� 5. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 6. Employees Familiar with HMMP <br /> 3.Business HMMP Complete and Accurate 7. Training Records Available <br /> 4.Chemical Description Pages Complete and Accurate 8. Unsafe Conditions Observed(see details below) <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> Y Q B v <br /> 3 �t da,�•c IZ/ � an G�cc, <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions ��" ,�It Additional / <br /> o Be Submitted By: U/— —0 Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTIW RESULTS <br /> usiness R resentative(Pn t Name and Title) Budin s epr n ve( ' azure) <br /> (✓1 WHITECOPY: OFS <br /> AQ 1 PINK COPY: BUSINESS <br /> REV 4110 <br />