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P <br /> oRRp!y COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> r. 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> ''- Telephone:(209)953-6200 <br /> `'<%FaAN`"• Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> B SIN $S N AADDDRESS(Facility Being Inspected) <br /> ACCOUNT# START DATE(New Bus) INSP N IODATE ARRIVAL TIME 'DEPARTURE TIME IN R AM <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Descriptio,Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> -22-D <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions -2,), lAdditional <br /> To Be Submitted By: , 22 1 D Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usmess Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> 1= PINK COPY: BUSINESS <br /> Rev 12A33 <br />