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Pqutry COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> w' 2101 E.Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> Fax:(209)953-6268 <br /> FGRN <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> o aE« . ,4T,44 ,75-07 AJ. /,�,tiy�ac�c Lam✓ 9,�L9 <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE I ARRIVAL TIME IDEPARTURE TIME INS�P/ECTOR NAME <br /> 9.59 �— /-2�-II � //30 �yLLt—.✓ <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 5. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 6. Employees Familiar with HMMP <br /> 3.Business HMMP Complete and Accurate 7. Training Records Available ✓t <br /> 4.Chemical Description Pages Complete and Accurate 8. Unsafe Conditions Observed(see details below) <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> 7V F,14S <br /> T !� f✓/ CU/L.�t n/ % CAn/ T� . <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: — � Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> F �OJnCe Eclmon 1`Ct� /L ^/m0� PINK COPY: BUSINESS <br /> v` aev 4110 <br />