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COUNTY OF SAN JOAQUIN <br /> ?•'�}' p� OFFICE OF EMERGENCY SERVICES <br /> r. ? 2101 E. Earhart Avenue,Suite 300 <br /> r: .a <br /> Stockton,California 95206 <br /> ""• Telephone: (209)953-6200 <br /> c'#�i cNN�P Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BU�INFSS NAME ADDRESS(Facility Being Inspected) <br /> f` k I 7,13E. Luc A ve—F <Aes�k Lol 0 9,52 <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE JARRIVAL TIME DEPARTURE TIME 1INSPECrOR NAME <br /> War) 2 9 i e I 11LOO `f 301 Ra6 e.. <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 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 /> 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 /> I <br /> Representative(Print Nam and Title) Business Represe we(S� t <br /> �- WH1TE COPY: OES <br /> % ���'� 7 !j PINK COPY: BUSINESS <br />