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Pr,Io,N COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> r. ? 2101 E. Earhart Avenue,Suite 300 <br /> ` Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> • ���IPC'RN�P• Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINJPS NAMEAD RESS(Facility Being Inspected) <br /> Reach l✓ ry`edlco 1 ?G <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE JARRIVALTIME DEPARTURE TIME INSPECTOR NAME <br /> t cZcf 7 to I I Lr 7,5 1 t F-10 at <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 /> 2.Business Identification Page Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate 8. 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 l <br /> To Be Submitted By: Referrals/Notes: / <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Busine/gs R res tive(Signature) µ.µITE COPY: OES <br /> II4',j/n C / PINK COPY: BUSINESS <br /> I��NIL.. J REV 11/06 <br />