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,t�ulq COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> Qt 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> �'I�/FOR~`'• Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> B 1 ESS NAME RES cility Being In petted) <br /> t <br /> A O START DATE(Ne Bus) INSP ON DATE I ARRIVAL TIME DEPARTURE TIME IN O NA Ift <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 Description 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 /> -a o - �- <br /> , . <br /> u v <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> o Be Submitted By: Referrals/Notes: <br /> CKNOWLEDGEM NT OIF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> sness-Representative(Print <br /> t Name and Title) Bu Representative <br /> ve(Signatur <br /> WHITE COPY: OESu (yk1^rA <br /> _0 PINK COPY: BUSINESS <br /> aEv Ivor <br />