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a 0 1 <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 2` 2101 E. Earhart Avenue, Suite 300 <br /> a: a <br /> Stockton,California 95206 <br /> _• Telephone: (209)953-6200 <br /> Fax:(209)953-6268 <br /> dtiFOPN <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> INESS NAME I ADDR(IRESS(jP0Fac,ity Being Inspected) <br /> i <br /> ACCO START T (New Bus) INSPECTION DATE ARRIVAL TIME DEPARTU TIME IN PECTO <br /> V NA E <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 /> i n a l �" <br /> i I i eeA- )5, Z010 . <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions y. �5 I�I V Additional <br /> To Be Submitted B Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTIO ESULTS <br /> Business Representative(Print Name and Title) Busi s R resen (Signature) WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> 02 <br />