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�C <br /> COUNTY OF SAN JOAQUI <br /> aPRyt"' ° OFFICE OF EMERGENCY SERVICES <br /> 2r ? 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 NAME <br /> G k P/v f a(/ TELEPHONE NUMBER <br /> 0,:� 31f <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 1860 w t 'i1-31 <br /> FIRE DISTRICT INSPECTIONDATE ARRIVALTIME DEPARTURETIME INSPECTO MF[AGENCY <br /> eL L.-L .5 <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate 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 7r- <br /> 5. <br /> 5.Training/Exercise Records Available 10.Conditions noted that could increase risk of release <br /> >1 <br /> or hinder implementation of emergency lan <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 Ins ection Date Referral Actions <br /> (ifappropria ❑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) mess Representati a(Signat q) <br /> WHITE[!b�� �. L �\ PINK OPYPY: 0 <br />