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opo.ulN o "-w COUNTY OF SAN JOAQUIN '-0 <br /> OFFICE OF EMERGENCY SERVICES <br /> r. 2101 E. Earhart Avenue,Suite 300 <br /> ` Stockton,California 95206 <br /> r Telephone: (209)953-6200 <br /> Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME I ADDRESS(Facility Being Inspected) <br /> AT&T MOBILITY 12a. N), OL V- . I— Ca A i <br /> ACCOUNT# START DATE(New Bus) INSP CTIO DATE ARRIVALTIME DEPARTURE TIME JINSPECT NAME <br /> L 1 O '140 0 '/,S-( ROBERT LOPEZ <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 5. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 6. Employees Familiar with HMMP <br /> 3.Business HMMP Complete and Accurate 7. Training Records Available <br /> 4.Chemical Description Pages Complete and Accurate 18. Unsafe Conditions Observed(see details below) <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> G <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> Submitted By: Referrals/Notes: <br /> SK11O7LEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usi ess Representative(Print ame and Title) Bus' es resentative(Sig tune) <br /> � wxrrE COPY: aEs <br /> PINK COPY: BUSINESS <br /> J� REV 4/10 <br />