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OPgUIq Q COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a: <br /> 'i 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> �''• Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUST SZ�o DR S(Facilit Being Inspec <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE ARRIVAL TIME DFP U$E TIME I PE OR A <br /> mLin <br /> INSPECTION RESULTS U <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 S. 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 /> l280 aTE 0 <br /> 0 cn — — <br /> NSPECTION FOLLOW UP INFORMATION <br /> orrective Actions 5, Additional <br /> o Be Submitted B Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usmess Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OFS <br /> PINK COPY: BUSINESS <br /> l..�D LS Cr REV t <br />