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Ink <br /> o PquiN C 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 /> 10. Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> SI SS NAME , y - ADDRESS Facility Bei I spected) <br /> AAQ M L <br /> ACCOUNT START DATE(New Bus) INSPECTION DATEA RIV L TIME D PARTURE TIME I SPECT R E <br /> - 2 wo <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 S. 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 /> b <br /> WVY Y \ <br /> -5v'baucuobi� C07 <br /> NSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> o Be Submitted By: Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usiness R/epre[sseentative/(�Print Name nd le),) t1�t� ,,,/ Business R�tatrve(Signature) <br /> p��t—I I '/I Al flC and1,Vt/ / WHITE COPY: OES <br /> �1/ Kl �' (�(,I t�.l PINK COPY: BUSINESS <br /> RFV 12/OY <br />