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COUNTY OF SAN JOAQUI <br /> ?olAQ.coa OFFICE OF EMERGENCY SERVICES <br /> ? ROOM 610, COURTHOUSE <br /> M` 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> BUSINESS NAM" <br /> AMHAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> E 'TELEPHONE NUMBER <br /> BUSINESS ADDRESS (F cility Being Ins cted) ZIP CODE <br /> VQ g Zoo <br /> IS RICT�n y� INSPECTION ATE ARR AL TIME DEPARTURE TIME IN OR A GENCY <br /> M L �,I�� mv) tzo?Dt <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 and Accurate 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate 8. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Available 10.Conditions noted that could increase risk of release <br /> or hinder implementation of emergency plan <br /> EXPL_1NATION OF FINDINGS AND COMMENTS <br /> 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)\ E]SJ Ag []SJ Env Hlth OSHA E]Fire [] Air Dist- U v <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Tide) Business Re resentative(Signature) <br /> WHrOES <br /> INK BUS C COPY:PINK COPY: BUS. <br /> 4 LIZ ' 4107 <br />