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Op,44!N C COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> Q 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> k.... . Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME 1D�RESS(Facility Being Inspected) <br /> t ►yka 54 <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATEARRIVAL TIME DEPARTURE TIME INSPE AME <br /> q6_12_?_ 10 -6-� 11_P10 <br /> � 6 tO n <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 01 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 <br /> o Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usiness Representative(Print Name and Title) B ss Re"n nve(Signature) <br /> WHITE COPY: OES <br /> EESS, PINK COPY: BUR <br />