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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> r` z ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE 2 F13 <br /> STOCKTON, CA 95202-2709 <br /> �1FOR BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> T y►�I.ob ( ' Lt- 500- �7z-(oVPZ <br /> BUSINESS ADDRESS(Facility Being Inspected/ �,_ - ZIPCODE <br /> � . � �2212-3 IJ . <br /> 2- <br /> FIREFIRE <br /> DISTRIC WSPECTION ATE ARR AL TIME DEPARTURE TIME INSPECTOR NALMEIAGENCY <br /> �o o�� <br /> _7/e O 8 / < <0 /�/3 d ,L�o�S / c am C}',s'J <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH Y!'-IS N0 <br /> 1.Business HMMP Complete and Accurate I/ 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate ✓ 8. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Available <br /> 10.Conditions noted that could increase risk of releas <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS/ <br /> �" 7 ���.n ��1�..�er �+- A X41 o T 14 a- '' <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 /> (if appropriate) SJ A ❑SJ Env Hlth DOSHA ❑Fire [:] Air Dist <br /> 2112-00f' ❑ <br /> .CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> ( PINK COPY: BUS. <br /> T'AU L c&6j qk) It4t) C C 1.1 l 6 4 r 4/07 <br />