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COUNTY OF SAN JOAQUI <br /> p4u " OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NA TELEPHONENUMBER <br /> BUSINESS ADDRESS(Favi ity Bei Inspe ted), ZIP CODE <br /> FIRE DISTRICT INSP I ON DATE 6 ��TUv1E DEPARTURE TU*IE INP R N�RI3�NCY <br /> DOCUMftNT REVIEW YES FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete curate 7.Chemical Inventory Comple[ ccurate <br /> 3.Business Identification P omplete and Accurate 8.Employees Farmtth HMMP <br /> 4. HMMP/Ma ty Accessible to Employees 9.Hazardou atertals/Waste Properly Labelled <br /> 5. mg/Bxercise Records Available 10.C Itions noted that could increase risk of release <br /> or hinder implementation of emergency Ian <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> NOTE: All HMMP documents except for the Facility Map can be created and updated on the San Joaquin County <br /> HMMP Compliance Website at www.sjoesdata.org. Contact OES for user name and password. <br /> INSPECTION FOLLOW-UP INFORMATION <br /> Corrective Actions Must Be Submitted By Follow-Up Inspection Date Referral Actions <br /> I El <br /> (if appropriate) ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑ Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> '� ^ I 1 WHITE COPY: OES <br /> ,` ri,„l� p V70Ne ,t r� / I PINK COPY: BUS. <br /> 'V !tel C.d ��J o (jrTl atn <br />