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Ai k <br /> pqU iN COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> Cq'•. <br /> fiN"P Fax: (209)953-6268 <br /> tlFO <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINES N ME ADDRESS(Fa 'I t Being Inspected) [1�C <br /> S CL © • • • �IGLA[K J t S <br /> ACC�OjU TART DA E(New Bus) INSP ION DATE ARRIVAL TIME DEPARTURE TIME IN PP c OR NAME <br /> /`�(1!f 97 �S X31 S w <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible Ll 6. Facility Map Complete and Accurate !/ <br /> 2.Business Identification Page Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals v- <br /> 3.Business HMMP Complete and Accurate . Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate L.,6. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> *+- /- y �� 6 � 6Le -ps, � ex / s1s, 6�e <br /> Z LYS 3 o� 1 S 0d�tiL�l/t cJ/ I� �iS � ttt <br /> frI t -� 1'_ A,O.��l '�. OJ I ear a c,r -�'� 0. "' 1 <br /> C0,0 ekm o, <br /> Y ` / L'-W/..t4N. <br /> 4/0 it 2 Ck L be 4e o r !� /-2- c I24?-ccr :c4- O et <br /> 5106­� 141 <br /> s Q f 0. C_i � Ty ppf <br /> Frib�t`or� Voo -P 0 1- ewt /o •e <br /> INSPECTION FOLLOW UP INFORMATION <br /> orrective Actions '�"� •� Additional <br /> To Be Submitted By: V w G7 ZQ 9 Referrals/Notes: <br /> ACKNOWLEDGEMENT OF IfEVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Re nt tive(Print am and le) Business Representative(Signature) <br /> WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> MAAreAl AM/[�1{�A,']��//f/{]/y[�/VJ//f/��f,J'�'��,/� / L/' REV ¢/OS <br /> h .l.n nAi [�/. /'.. i l/ Ili. AG. -/T/hAY ) <br />