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Pqt,+y COUNTY OF SAN JOAQUIN <br /> c OFFICE OF EMERGENCY SERVICES <br /> r 2101 E. Earhart Avenue, Suite 300 <br /> R: <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> cR<<Foge+`P Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAM ADDRESS(Facility Bung Inspected) <br /> ( cxc IG 14 <br /> ACC 'G <br /> 1 <br /> OUNT STA T DAT New Bus) INSPECTION DATE JARRIVALTIME DEPARTURE TIME INSPECTOR NAME <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 /> 1 2.Business Identification Page Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals <br /> E] <br /> 3. Business HMMP Complete and Accurate 18. 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 /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> o Be Submitted By: Referrals/Notes: <br /> 'ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INS_EDE710N REWL <br /> Business Representative(Print Name and Title) Business Repr e t ve S ture) <br /> l WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> REV 12/08 <br /> 1 <br /> 1 <br />