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%W01 S.1 <br /> a4�ulN COUNTY OF SAN JOAQUIN <br /> ?• �Q',oma OFFICE OF EMERGENCY SERVICES <br /> r. s 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> -= Telephone:(209)953-6200 <br /> Fax:(209)953-6268 <br /> �ci adRN <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUST SS NAME ADDRESS(Facility Being Inspected) <br /> Pm 1 lc w <br /> ACC UNT# START DATE(New Bus) INSPECTIIO�N DATE I ARRIVAL TIME DEPARTU TIME INSP NAME <br /> d c! Q <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES Ngr <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are abse <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> da 5( 11 Psi 110 <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 /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> REV Iv <br />