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COUNTY OF SAN JOAQUIN <br /> p4u " OFFICE OF EMERGENCY SERVICES <br /> ' ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NI;MBER <br /> A0 <br /> 209 209- s - 770 <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> A9/_5_ w 4�gV ZW 7-0 A/ rzo <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME I INSPECTOR NAMFIAGENCY <br /> ZL 1 7-23=o7 Z 3O i6veZL f �t�✓ OES <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 releas <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> /2 t MP ,460& <br /> N70LY GL��77ow/ <br /> eC E •• P <br /> — Fslrti a c c Co Yr an/ o v A11A1C- <br /> c Fvo r— ro cD ry aer. <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 Fire [] Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> LBusiness Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> PINK COPY: BUS. <br /> SSI a ✓ am <br />