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Ask <br /> OP�u1N C COUNTY OF SAN JOAQUIN <br /> ? `•o� OFFICE OF EMERGENCY SERVICES <br /> a2101 E. Earhart Avenue,Suite 300 <br /> J. Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> C9�l PGPN`P Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> USINESS NAME ADDRESS(Fa ility "ng Inspected) <br /> A,C,COUNT ISTART DATE(New Bus) INSPEECrII IN DATE I ARRIVAL TIME DEPARTURE TIME INSPECTOR NAM <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 /> INSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> o Be Submitted By: Referrals/Notes: <br /> kCKNOWLEPQEMENT OF REVIEW AND RECEIPT OF INSP C ON RESULTS <br /> usiness Re a entative(Pri Name an I if itle B si s epresentanve(Signature) <br /> ^ ES <br /> PINK C COPY: US <br /> l0, PINK COPY: BUSINESS <br /> REV 11108 <br /> v <br />