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COUNTY OF SAN JOAQUIN <br /> �o. .caG OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> ��lFC�N <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME I TELEPHONE NUMBER <br /> .Caw��L S)Cik_. HiVh' T5 AD <br /> BUSINESS ADDRESS (Facility Being Ins cted) ZIPCODE <br /> FIRE DISTRICT INSPECTION DAT ARRIVALTIME IDEPARTURETIME INSPECTORNAMEIAGENCY <br /> � 0 <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 an rate 7.Chemical Inventory Complete ancurate <br /> 3. Business Identification Pa c mplete and Accurate 8. Employees Familiar w' MMP <br /> 4. HMMP/Ma I y Accessible to Employees 9.Hazardous M ialsAVaste Properly Labelled <br /> 5. Tr " tng/Exercise Records Available 10.C tons noted that could increase risk of releas <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> um h ra <br /> SyS-- a <br /> Co <br /> 15�s� <br /> C' 0�C"Con L�) 0- 0-0-7 <br /> s, 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 Inspection Date Referral Actions <br /> (if appropriate) ❑SJ Ag ❑SJ Env Hlth OSHA ❑Fire Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Tide) Bus] epresentative(Signature) <br /> WHETS COPY: OE5 <br /> v PINK COPY: BUS. <br /> 4107 <br />