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s <br /> oPQ"lN c COUNTY OF SAN JOAQUIN } <br /> ? '•oma OFFICE OF EMERGENCY SERVICES <br /> a ?.� 2101 E. Earhart Avenue, Suite 300 <br /> W ` Stockton, California 95206 <br /> Telephone: (209)953-6200 <br /> Cq�li=OgN`P Fax: (209)953-626$ <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> B SINESS NAME ADDRESS(Facility Being Inspected) <br /> Yfl kk�hASVAV.., P'n' k I <br /> ( I __ aA I <br /> ACCOUNT# TART DATE(New Bus)jl(SPEgl(()N DATE ARRIVAL TIMI E DEPARTURE TIM 11);PECTORNAM <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[Ion-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate S. 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 riskof release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS EE <br /> \ vain 1 -f- d .so lir <br /> A <br /> 10, <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: lo Referrals/Notes: <br /> ACKNOWLEDGEMENT OFR IEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Repre Tvc(Signature) <br /> U WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> REV 12ID8 <br />