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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> r` ? 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 /> JA �'` mss- v9- f7- 4� <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> CA IV A4V CAl. J;++CC k7-0�✓ Z/F <br /> FIRE DISTRICT INSPECTION DATE JARRIVALTIME DEPARTURE TIME JINIPECTORNAMFJAGENCY <br /> 2_21- -72(o-D7 //:O © z4vez 1- 14 t-tA/ /0675- <br /> DOCUMENT <br /> F5'DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business H EAP 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 .Conditions noted that could increase risk of release <br /> or hinder implementation of emer enc lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> - tArl NEcI�S ,Qt s'/Ft✓ .�/�9�c� .ce <br /> �1 VIW- rto r- Gc u4A_eT/ r 1n/Fe2"� n! <br /> �.S' >� �' EM/GaYG`�S i+/t'Z"� �o .�r2m.�� fAM�Li�4�C/2t'D i?►� <br /> t <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 /> 7 (if appropriate) E]SJ Ag E]SJ Env Filth OSHA Fire ❑ Air Dist <br /> 1 ❑ <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHIOES <br /> PINK CO COPY: BUS <br /> PINK COPY: BUS. <br /> 4107 <br />