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Et�uly COUNTY OF SAN JOAQUIN " <br /> so. .co` OFFICE OF EMERGENCY SERVICES <br /> a 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> t`'• Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> s ra - oc'rlx�f�4 1 30©3 e7-. <br /> .S�r/MNE.2 W. 9tz/Z <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTOR NAME <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 t/ <br /> 4.Chemical Description Pages Complete and Accurate V11119. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 10. Conditions that would hinder implemenmtion of <br /> Emergency Plan or increase risk of release are absent I L--- <br /> EXPLANATION <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> INSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name andTitle)tle)_ Business Representative(Signature) <br /> WHITE COPY: OES <br /> )(25K12--Lf, <br /> I G _ O 5U PINK COPY: BUSINESS <br /> REvty <br />