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COUNTY OF SAN JOAQUIN <br /> a4tA �c OFFICE OF EMERGENCY SERVICES <br /> ' A 2101 E. Earhart Avenue,Suite 300 <br /> •: ' Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> Fax:(209)953-6268 <br /> • �CIFOR�`P <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> Cr/1SS �(J(J/n6E1G ,d i�,pu��6 GG3 �S ge <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE ARRIVAL TIME DEPARTURE TIME JINSPECTOR NAME <br /> X06 g ie o rho // d �T c�47,A. G� <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible Z 6. Facility Map Complete and Accumte <br /> 2.Business Identification Page Complete&Accurate - 7. Presence of Non-Listed Regulated Chemicals <br /> 74 <br /> 3.Business HMMP Complete and Accurate V X 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 10. Conditions that would hinder implementation of <br /> 5.Training Records Available Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> .�✓�.t� oa y` /�✓GiV�.vT �f ��-roi✓�O.vpue> �'c�as�" <br /> �a'.� ,raavr8 To STos� C6.y� d�✓ li ust' iz 7�io <br /> o F wswla w.as CG.riOIiGT�D�GZt r�d� <br /> s A G✓�G� Tfi. rl>iY� rGrLj>y To d.�� 6����Gs R.�o <br /> S �c1i�.r✓ �F,pr�©.rir 661ui�i.��,r�T <br /> �iYE/�/✓..�T,�s�� ��oCe�s'..I ,a,-t.,a �.eoBce� wl>H >.y'� didCv� <br /> uJi.�G >.li� ,e,�Ls cam' /✓.�2.� a66.�co��r��. Ti�� Com .vim �. <br /> dr/6�Eve.�O Til�a <br /> /,Vow Ccr`.r,c d`�i.ri�T•a�iiw <br /> Syeiw v�lv T�Y� A2B ��O�G SN.�E rc� �.Ed li6�ir%� <br /> yasd,�d� itis N,gSTo�s � i:✓ >���zP�.�i'�i¢6 ,,sem-. <br /> INSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> o Be Submitted By: f/(/p/b Referrals/Notes: NISI✓8 <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Repr entati rat Name and Tide ' Business Representative(Signature) WHITE COPY: OFS <br /> /1 PINK COPY: BUSINESS <br /> REVI <br />