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a <br /> Pq�rN COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE f <br /> STOCKTON, CA 95202-2709 <br /> C4<<FORN,P <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> 81(A �� <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 7 In'La K -f-ti .r <br /> FIRE DISTRICT INSPECTIONDATE ARRIVALTr E DEPARTURE TIME INSPECTORNAMEJAGENCY <br /> 6— <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1. Business HMMP Complete and Accurate b.Facility Map Complete and AIccurate <br /> 2.Chemical Description Pages Complete and Accurate 7.Chemical Inventory Complete and Accurate <br /> a. <br /> 3.Business Identification Page Complete and Accurate S. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 10.Conditions noted that could increase risk of releas <br /> 5.Training/Exercise Records Available or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS !� <br /> i <br /> 1 0!1 <br /> ,I <br /> Q ( t ,! ew <br /> I[ <br /> i <br /> 1 <br /> R� <br /> I�r <br /> I <br /> I� <br /> i <br /> a� <br /> i <br /> NOTE: All HMMP documents except for the Facility Map can be created and updated 3n the San Joaquin County <br /> HMMP Compliance Website at www.sjoesdata.org. Contact OES for user name and password. <br /> INSPECTION FOLLOW-UP INFORMATION j <br /> Corrective Actions Must Be Submitted By Follow-Up Inspection Date Referral){Actions <br /> (if appropriate) 1:1 SJ Ag ❑SJ Env Hlth EOOSHA Fire [:] Air Dist <br /> El <br /> l� <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS J. <br /> Business Representative(Print Name and Title) Business Representative(Signatufe) <br /> WHITE COPY: OES <br /> PINK COPY: BUS. <br /> F 4/07 <br /> r <br />