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COUNTY OF SAN <br /> OFFICE OF EMERGENCY SERV ICES <br /> c' 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> -- Telephone: (209)953-6200 <br /> Fax:(209)953-6268 S. <br /> �IFCPN <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSI SS NA - A DRF.S�(Faty Being Inspected <br /> rt_ <br /> YO <br /> ACCO,VA# START ATE(New Bus) INSP I NDATE ARRIVAL TIME DEPART}J �IME INSP OR G <br /> / 37�f s � io iS�S i <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 tl 7. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Descriptiou Pages Complete and Accurate . Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPL N TTQN I FINDINGS AND COMMENTS <br /> Z ?0- .- . 2f0 O,< e.1 0_' <br /> ,$-0 0 - a,& n 146 7L4 e__ /p4 v err.�0,e <br /> o ze?Y�d_e-4, e_-e-)4- �6 . <br /> INSPECTION FOLLOW UP IN ORM TION <br /> Corrective Actions V Additional <br /> To Be Submitted By: S//✓��V Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSP_WZION RESULTS <br /> ust ess Representauve(Print ame and Title) usme ntatl ig toWHITE COPY: CIES <br /> ) <br /> PINK COPY: BUSINESS <br /> REV 12108 <br />