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oPuly`-c COUNTY OF SAN JOAQUIN <br /> ? ' '•oma OFFICE OF EMERGENCY SERVICES <br /> H 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 /\ <br /> ' Telephone:(209)953-6200 <br /> t`q'•- :� Fax:(209)953-6268 <br /> �1FGRN <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> C. ©u�-3�- & sr c'. os- <br /> ACCOUNT k START DATE(New Bus) INSPECTION DATE I ARRIVAL TIME IDEPARTURE TIME INSPECI'OR NAME <br /> /Z q10 /l -© 0930 1 <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 r/ <br /> 2.Business Identification Page Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate 1/" 8. 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 /> 171 1Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> USin/e3 c~ 7-04*6- PA,4-c7-7CEs Fm.L 2A-,Y�c7vc'7- <br /> o <br /> INSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usiness Representative(Print Name and Tide) Busi Representative(Si nature) <br /> WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> REV 1906 <br /> t <br />