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0 • <br /> PQut, COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> Q' a 2101 E. Earhart Avenue,Suite 300 <br /> "'• ` " Stockton,California 95206 <br /> Telephone:(209)953-6200 nn•• <br /> ...�4CtFo'at''P• Fax:(209)953-6268 7✓- Z 0 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BU NESS N�IME II ADDRESS(Facility Being Inspe ted) �, / / e <br /> �✓ adl (.tgt ZZ07 a U b Sx/9! fo <br /> A COUNT# START DATE(New Bus) INSP 10 ATE ARRIVALTI DEPARTURE TIME INSPECTOR NA E <br /> jo <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 V 7. Presence of Non-Listed Regulated Chemicals 1/ <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Descriptiou Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 0. Conditions that would hinder implementation of <br /> g Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> I <br /> In <br /> :I CC /1'-0. fUi <br /> ? l T ✓OVcVon 10 e� � ✓ `� t ,•� <br /> INSPECTION FOLLOW UPI FORMATION <br /> Corrective Actions X Additional <br /> To Be Submitted By: � b 6 Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usiness Representative(Print Name and Tule) Business Representative(Signature) WHI'ig COPY: OFS <br /> �{ , n PINK COPY: BUSINESS <br /> CO l 1 2 V 1 I q ttev lvos <br />