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�Qu(y COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> y2101 E. Earhart Avenue,Suite 300 <br /> e: <br /> Stockton,California 95206 <br /> ""• Telephone:(209)953-6200 <br /> Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> Rulme a9L- D76 C/J Q A✓r e- lcc�ti <br /> ACCOUNT NSTAR DATE(New Bus) INSPECTION DATE ARRIVALTIME DEPARTUR TIME INSP OR N"E <br /> IIgk / q-% 5 131 t� D u <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 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 absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> G <br /> 60rreGIfa (.[ a k7 �t o C1 C4 ✓t n e7 AOe- 6c. <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> o Be Submitted By: Referrals/Notes: ✓ <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Buse s Representati ( ignature) <br /> WHITE COPY: OES <br /> T 1 �r7 <br /> PINK COPY: BUSINESS <br /> v .W REV Iv <br />