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oPRuly COUNTY OF SAN JOAQUIN <br /> ? ' '•o� OFFICE OF EMERGENCY SERVICES <br /> b 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> �q•. .p <br /> Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME / 1 !a Q ADDRESS(Facility B ing Inspected) <br /> ACCOUNT k START DATE(Ne Bus) INSPECTION DATE ARRIVAL'y-T(I�IME DEPARTURE TIME INSPE OR NAME <br /> 12-23-� I�fi 14 <br /> r <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 <br /> 4.Chemical Description Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> hu rla <br /> clan n -ec <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referral /Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(S' ature) <br /> WHITE COPY: OES <br /> ns . �IJ PINK COPY: BUSINESS <br /> J REV 12/08 <br />