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a,Quly COUNTY OF SAN JOAQUIN <br /> ? �. '•9c OFFICE OF EMERGENCY SERVICES <br /> e.4 2101 E. Earhart Avenue, Suite 300 <br /> a: <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> oq�iFOR`':P Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSIN SS NAME ADDRESS(Facility Being Inspe ted) <br /> >< ria✓ I I q4 Pei <br /> ACC NT# START DATE(New Bus) INSPECTIO AT ARRIVAL TIME DEPARTURE TIME INSPECTOR NAME <br /> -/I r V � <br /> [o _6 L <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 l0. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of=are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> (en✓tcdt rt n V1 2C' fffrM <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: , Referrals/Notes <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPEC ON ESUL <br /> usiness Representative(Print Name and Title) Busi ess R presentative(Sign ure) <br /> COPY: oES <br /> N ' PINK COPY: BUSINESS <br /> REV 12108 <br />