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Pqu�y COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone: (26200 <br /> • � `Pig Fm:(2 953-62 <br /> ,��FORa <br /> HAZARDOUS MATERIALS PROG INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected))! <br /> qapo 0¢ Q c6a P TU•ne Lt 2,1-t5- Lvat 1e Ca <br /> A OUNT# START DATE(New Bus)JINSPFCTION DATE JARRIVAL TIME IDEPARTURE TIME INSPE OR N ME _ <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 /> w4e C60L 4 <br /> " IfL ef <br /> h �kkL <br /> A YIt rcu c n t-& <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions ((�� Additional / <br /> To Be Submitted By: — Q 10 Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESUL <br /> [Eness Representative(Print Name and Title) Bust five( ignature) WHITE COPY: OES <br /> PINK COPY BUSINESS <br /> Y'` J REV 12/08 <br />