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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> �., ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE /2 R <br /> �.. STOCKTON, CA 95202-2709 <br /> A�IFOiRN` BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAM _ TELEPHONE NUMBER <br /> 540-2- <br /> BUSINESS <br /> BUSINESS ADDRESS(Facility Boeing Inspected) ^ ZIPCODE <br /> 7�� V Q P. e' [ og -e- 12y/' ��b C_ / �_2_/ <br /> FIRE DISTRICT INSP 0 DATE JARRIVALTEAE DEPARTURETUINSPECTOR NAMEAGENCY <br /> L—in 1 �o c ©dr // 4-0 -b ��e,�-� �i Dmf' <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate ei <br /> 2.Chemical Description Pages Complete and Accurate 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate 8.Employees Familiar with HMMP v <br /> 4.HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled c/ <br /> 10.Conditions noted that could increase risk of releasei <br /> 5.Training/Exercise Records Available � or hinder implementation of emergency plan <br /> EXPL'I,NATION OFa FINDINGS AND COMMENTS L �j <br /> *14 <br /> '� i s^ t2 u✓/tic T c�.-� oY o - <br /> IV <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 Actions <br /> (if appropriate) 11 SJ Ag [:]SJ Env Hlth OSHA ❑Fire [:] Air Dist <br /> 7 2®� � ❑ <br /> KNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULT <br /> Business Repro ntative(Pr' t am and Title) Business epre tative(Sin u ) <br /> WHITE COPY: US <br /> �A PINK COPY: BUS. <br />