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• 0 . _ _ <br /> PpuIN COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a' 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> • Telephone: (209)953-6200 <br /> �q(/FCRN`P Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUST SS NAME / ADDRESS(Facility Being Inspected) <br /> ACCOUNT# START DATE(NeW Bus) INSPECTION DATE I ARRIVAL TIME IDEPARTURE TIME JINSP OR NAME - <br /> 3 2- - lo l 3 axi I Gni a0 <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 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 /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> tree L�e (f u ki 510-echely\ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions / Additional <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Tide) Business Representative( ignature) <br /> _ WHITE COPY: OES <br /> PINK COPY: BUSINESS <br />