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COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />VY a ROOM 610, COURTHOUSE <br />". .; 222 EAST WEBER AVENUE . 77 j <br />STOCKTON, CA 95202-2709 <br />BUS. (209) 468-3969 FAX (209) 468-0273 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NANJE <br />TELEPHONE NUMBER <br />pa <br />hTk 7- <br />ql,r s-'?o- <br />BUSINESS ADDRESS (Facility Being Ins a ted) <br />- _�7C-4kc-7 <br />d <br />ZIP CODE <br />�,!�-2 <br />5 <br />. T4, o, e-, )e ------- <br />L <br />FIRE DISTRICT <br />INSP N D TE ARR VA IME <br />1/Z(�Icpl <br />DEPARTURE TIME <br />INSPECTOR AME/AGENCY <br /><7/)—k <br />I Z <br />n r 4 <br />_L - <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP 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 />;/ <br />9 Hazardous Materials/Waste Properly Labelled <br />5. Training/Exercise Records Available <br />10. Conditions noted that could increase risk of releas <br />or hinder implementation of emergency lan <br />EXPLANATION OF FINDINGS AND COMMENTS <br />/ <br />- 0 /20S �a- _7� - <br />�-, • <br />� d �- <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 <br />Follow-Up Inspection Date <br />Referral Actions <br />(if appropriate) <br />❑ SJ Ag ❑ SJ Env Hlth ❑OSHA ❑ Fire ❑ Air Dist <br />CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Represe tive (Pri N e and Title) <br />Business presen v (Signature) <br />WHITE COPY:OES <br />PINK COPY: BUS. <br />T/' <br />4✓07 <br />