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*00, <br /> Q <br /> COUNTY OF SAN JOAUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> r` 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> c4<lc GPe'�' Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSWPSS NA ADDRESS(Fa ility Being Inspected) <br /> ACCOUNT# START T (New But) INSPECTIOON DA IN ARRIVALTIME DUP RTURE TIME I SPE O NA <br /> -_ CUIXoNg— <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 /> II 4 11,loW7noj11M Al <br /> g <br /> INSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> o Be Submitted By: Z� .Q 61 Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> uslness epresentative(Print Name and Title) Bushes,Re s ntat ignatore) <br /> N <j0 EN R I (5 PINES <br /> K NCOPY: US <br /> PINKK C COPY: BUSINESS <br /> REV <br />