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COUNTY OF SAN JOAQUIN 9c.7-575- <br /> OFFICE OF EMERGENCY SERV ICE <br /> r.' Z <br /> a' 2101 E. Earhart Avenue, Suite 300 /Cel- <br /> a: : i< <br /> Stockton,California 95206 <br /> • �., - .�� Telephone:(209)953-6200 <br /> i)i6w� Fax: (209)953-6268 L L <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> 7—A 7-2-07 eocc�, ale . <br /> ACCOUNT#_ START D <br /> 4ATE(New Bus) INSPECT' ON ATE ARRIVAL TIME DEPARTURE TI INSP CI'OR AMr <br /> 20 <br /> —e✓ �0 C i <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> . 1.HMMP/Map On Hand and Lasily Accessible 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete& curate <br /> Eence of Non-Listed Regulated C icals <br /> 3. Business HMMP Complete and urate loyees Familiar with H <br /> 4.Chemical Description es Complete and Accurate 9. Hazardous Materials/W ste Properly Labelled <br /> 5.Training Records Available 10. Conditions that would hinder implementation of 1 <br /> Emergency Plan or increase risk of release are absent 1 ! <br /> EXPLANATION OF FINDINGS A COMMENTS M <br /> Jx 200 ou , <br /> O or—"" d C !no( tr S <br /> A 1 <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> M B�essn���Representative(SignatBusness Repesentative(Print Name and Title) ure) <br /> WM ES <br /> SGO'� Qk!S W k 0. 14k PINK COPY: BUSINESS <br /> ��` <br /> REV 12/08 <br />