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Ah Ak ! 30 3 <br />COUNTY OF SAN JOAQUI <br />OFFICE OF EMERGENCY SERVICES <br />r ` a ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE <br />STOCKTON, CA 95202-2709 <br />'OCIFORN BUS. (209) 468-3969 FAX (209) 468-0273 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME <br />P_ <br />TELEPHONE NUMBER <br />SZ(q 79l <br />BUSINESS AD TRESS (Facility Being Inspected) <br />' <br />l ��� W � <br />�CODE / <br />ZIP <br />—L C7 (S3 6 <br />FIRE DISTRICT <br />INSP ON DATE <br />JARRIVALTIME <br />DEPARTURE TIME <br />I INSPECTOR N)�MMAGENCY <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. Business HIVIMP Complete and Accurate <br />6. Facility Map Complete and Accurate <br />2. Chemical Description Pages Complete and Accurate <br />7. Chemical Inventory Complete and Accurate <br />3. Business Identification Page Complete and Accurate <br />8. Employees Familiar with HMMP <br />4. HMMP/Map Easily Accessible to Employees <br />9. Hazardous Materials/Waste Properly Labelled <br />5. Training/Exercise Records Available <br />-/ <br />�` <br />10. Conditions noted that could increase risk of releas <br />or hinder implementation of emergency lan <br />EXPLANATION OF FI INGS AND COMMENTS <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 tions <br />(if appropriate) ❑ SI Ag ❑ Si Env OSHA []Fire ❑ Air Dist <br />0-6A 1 / ❑ <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative (Print Name and Title) <br />ol�/h/5 t/ <br />Business Representative (Signature) <br />WHITE COPY: OES <br />PINK COPY: BUS. <br />4107 <br />