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COUNTY OF SAN JOAQUIN \J <br /> OFFICE OF EMERGENCY SERVICES <br /> q 2101 E.Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(709)953-6200 <br /> �`4C1Fa.R�i:p Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> 7�tdS 2 C,i o z <br /> ACCOUNT# START DATE(New Bus) INSPECTI N D E ARRIVAL TIME DEPARTURE TIME INSPECTOR NAME <br /> / <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.BMW/Map On Hand and Easily Accessible 5. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate ✓ 6. Employees Familiar with HMMP <br /> 3.Business HMMP Complete and Accurate 7. Training Records Available <br /> 4.Chemical Description Pages Complete and Accurate 8. Unsafe Conditions Observed(see details below) <br /> EXPLANATION OF FINDINGS AND COMMENTS - <br /> „/�ufi .Jt`Sf cc iGicy �.9 Zc/z _ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> (iC /t� (ZOYj N ON to J L M A/f16 PINK COPY: BUSINESS a/0 <br />