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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 'ate'COc <br /> r' ? ROOM 610, COURTHOUSE <br /> q' 222 EAST WEBER AVENUE <br /> �. aciPR�;;4 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 /> Srst-�wL../ W L_e_i44t45 57VIC-e- Z #/.3/07 12-W9- 5/7,P- /o/y <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> ,33(!) c.. /4*v/+fr-+¢_ csc 9SZ/2- <br /> FIRE DISTRICT INSPECTION DATE ARRNAL TIME DEPARTURE TIME INSPECTOR NAMFIAGENCY <br /> /v o 5— <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 Acc 7.Chemical Inventory Complete a <br /> 3.Business Identification Page C ete and Accurate 8. Employees ar with HMMP <br /> 4. HMMP/Map E ccessible to Employees 9 ardous Materials/Waste Properly Labelled <br /> 5.Tr ' xercise Records Available 10.Conditions noted that could increase risk of releas <br /> or hinder implementation of ern enc lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> Kat t�--n s nF S N1� e To Crlt�.tel <br /> cf <br /> s �Le o <br /> .4 {�E�4G/ �'�r/en/ Fse- <i•Atz nest/ To P/f/O7 /.4/er770.1- <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 DES 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) El ID SJ Ag [—]SJ Env Hlth [:]OSHA ❑Fire Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Bus�in(e�ss ReprFsett-iCe(Print Name and Title) Business Represen ive(Si_ 4 ure) <br /> S Z KpPtt 6Jl�t1 WHO( PY: OFS <br /> PINK COPY: BUS. <br /> A o\ e r 4/0 <br />