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COUNTY OF SAN JOAQUI <br /> °►�° " OFFICE OF EMERGENCY SERVICES <br /> ROOM a 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> ca`'poR�'T BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> 0 0 qL ks &/ R Lf , /37 <br /> ,21 <br /> BUSINESS ADDRESS(Facility Being nspected) ZIPCODE <br /> ZOO E. Ole-;.t s f. s 9�Zo 2- <br /> FIRE DI TRICT INSPECTIONDATE ARRIVAL TIME DEPARTURE TIME INSPECTOR NAMEIAGENCY <br /> S C�fZ9rt 5.20 O � 3� �6T•-r /-� O� <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1. Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and A e ✓ 7.Chemical Inventory Complete and Accur <br /> 3.Business Identification Page Coa and Accurate 8. Employees Familiar with HM <br /> 4. HMMP/Map Easi cessible to Employees 9.Hazardous Materiaste Properly Labelled <br /> 5.Training/Exercise Records Available 10.Condited that could increase risk of releas <br /> ti o <br /> oriflEnder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> a K d A&C_ <br /> o v ' /Do e..+0o e zoo <br /> 10, <br /> SD O o Q /, ,� ate.W O U e - Soo o�c„ <br /> NOTE: All HMMP documents except for the Facility Map can be created and updated on the San Joaquin County <br /> HMMP Compliance Website at www.sjoesdata.org. Contact OES for user name and password. <br /> INSPECTION FOLLOW-UP INFORMATION <br /> Corrective Actions Must Be Submitted By Follow-Up Inspection Date Referral Actions <br /> (if appropriate) SJ Ag []SJ Env Hlth OSHA ❑Fire ❑ Air Dist <br /> V LAIV%t a, 200 a- <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Represe ative(Print Na and Title) Business Represent ve na <br /> WHITE COPY: OES <br /> 6'D 1 el J h et/� PINK COPY: BUS. <br /> t 4/07 <br />