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oPgt1IN O COUNTY OF SAN JOAQUIN <br /> ? ' '•oma OFFICE OF EMERGENCY SERVICES <br /> a` 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> • -= Telephone: (209)953-6200 <br /> �,�ieokNSP <br /> Fax:(209)953-6268 d <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> AT&T MOBILITY -710 T-1y . <br /> ACCOUNT# START DATE(New Bus) INSPEEE�CCCTTI N DATE ARRIVAL TIME DEPARTTUURE TIME INSPECTOR NANIE <br /> Z� 3I ` izot� /03a /00? 1 ROBERT LOPEZ <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 5. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate V <br /> 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) v <br /> EXPLANATION OFF NDINAN COMMENTS L / <br /> ^ lOI74 4,p-- t I 'Q- i 0 7 CC.I ak <br /> K <br /> . <br /> INSPECTION FOLLOW UP INFORMA ON <br /> Corrective Actions C?bAdditional <br /> Submitted By: Referrals/Notes: <br /> A OWLEDGEMENT OF'REVIEVV AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative( nt Naaa���jte and Title) Business Repre nta[iv ignature) <br /> / / PINK COPY: <br /> US <br /> Jo QQ PINK COPY: BUREvato <br />