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PgU[Iy y/ COUNTY OF SAN JOAQUIN <br /> �o. .co` OFFICE OF EMERGENCY SERVICES <br /> Q a 2101 E. Earhart Avenue, Suite 300 <br /> a' ` Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> N�. Fax:(209)953-6268 <br /> ,�IFOP� <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BU INES NAME ADDRESS(Facility Be, g In cted) <br /> Jalrl U) <br /> ACCOUNT# START DATE(New Bus)JIPEqION ITE ARRIVAL TIME DEPARTURE TIME INSP CT R N ME <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO ITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible Facility Map Complete and Accurate <br /> 2.Business Identification Page Complet ccurate 6. Employees Familiar with HMMP <br /> 3.Business HMMP Co a and Accurate 7. Training Records Avail <br /> 4.Chemic scription Pages Complete and Accurate 8. Unsafe C Ions Observed(see details below) <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usmes Representative(Print Name and Title) Business Re resentative(Signatur <br /> WHITE COPY: OPS <br /> "Tj_ � PINKCOPY: BUSINESS <br /> c <br />