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AML <br /> Pauly COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209).953-6200 <br /> Fax:(209)953-6268 e <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM /f 6 <br /> INES N E ADDRESS(Facility Being Inspected) <br /> ACCOUNT# START DATE(New Bus) INSPIO ATE ARRIVALTIME DEPARTURETIME INSPECT R <br /> 27 o i�-T6 !s <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> . 1. HMMP/Map On Hand and Easily Accessible L/ 6. Facility Map Complete and AccurateO �,� � ,1 <br /> 2.Business Identification Page Complete&Accurate v 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 I L,110. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS / <br /> etc C' <br /> C� Cp�� <br /> Q C© VL O 0. <br /> �— FQtM I javl +--4-- <br /> 9 <br /> t---9 <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: �/ 71W Referrals/Notes: <br /> ACKNOWLEDGEMENT OF RCVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Priq N me and Title) Business Representative(Signature) <br /> � <br /> WHITE COPY: OES�t I y WG PINK COPY: BUSINESS <br /> REV IY08 <br /> i <br />