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qurN COUNTY OF SAN JOAQUIN '�d <br /> OFFICE OF EMERGENCY SERVICES <br /> '2 <br /> 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> ' <br /> Telephone:(209)953-6200 <br /> Far.: (209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> MMME ADDRESS(Facility einem nspected) <br /> OUT# START ATE( Bus) INSPECTION D TE ARRIVAL TIME DEPART RET E INSPE R AMF/'j <br /> /INSPECTION RESULTS tf�/ <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> I.HMMP/Map On Hand and Easily Accessible 5. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 6. Employees Familiar with HMMP <br /> 3.Business HMMP Complete and Accurate 7. Training Records Available <br /> 4.Chemical Description Pages Complete and Accurate 8. Unsafe Conditions Observed(see details below) <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> a,m + trial( <br /> INSPECTION FOLLOW UP INFORMATION <br /> orrective Actions (]J/1 r�_ l o Additional <br /> To Be Submitted By."� W Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESUPS <br /> Business Repre native(Print Name and Title) Business Wall e) <br /> WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> REV M10 <br />