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Q� N COUNTY OF SAN JOAQUIN <br /> 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 NUMBER <br /> ►�`�7o� nt_�` � *�2dogz -49d05- 9sq- os©Z <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 2Lt t v. ►1� l� S ro C_tc:--0 C4 <br /> P9�z o o <br /> FIRE DISTRICT INS / O DATE ARRIV TIME DEPARTURE TIME INSPECTOR <br /> zz d`ZP /y—r0 I /_1•r_L_crt / otS <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 Ian <br /> EXPLANATION 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) ❑SJ Ag ❑SJ Env Hlth []OSHA ❑Fire ❑ Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business l presentative(Print Name and itle) Business Re ntative(SignaI e) <br /> t\ C WHITE COPY:JUS. <br /> 0-11 PINK COPY: <br /> r / <br />