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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE /Z 7F Z <br /> STOCKTON, CA 95202-2709 <br /> C���FpRN�P BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME /�y/ TELEPHONE NUMBER <br /> TS,I i'/<o k 800 63d'. Zg22 <br /> BUSINESS ADDRESS(Facility Being I pected) ZIPCODE <br /> 2a �Q S`� /,/�✓ `j /�01. �i o✓l C/ 44 <br /> 10 j <br /> FIRE DISTRICT INSP O �}ATE A AL T1M DEPARTURE TIME INSPECTOR NAMEIAGENCY <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH _ YES NO <br /> 1.Business HMMP Complete and Accurate +/ 6. Facility Map Complete and Accurate L� <br /> 2.Chemical Description Pages Complete and Accurate 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate 8. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Available <br /> 10.Conditions noted that could increase risk of release <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> 000�.'ho , e, )z <br /> IV e— /142,01' 0/7' 11 -e— d2�e&�,r6p'plz <br /> a -SN-P 4,0 <br /> NOTE: All HMMP documents except for the Facility Map can be created and updated on the San Joaquin County <br /> HMMP Compliance Website at www.sjoesdata.org. Contact OES for user name and password. <br /> INSPECTION FOLLOW-UP INFORMATION <br /> Corrective Actions Must Be Submitted By Follow-Up Inspection Date Referral Actions <br /> (if appropriate) SJ Ag [:]SJ Env Hlth OSHA Fire [:] Air Dist <br /> Xt oOSO' <br /> ,'KNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Bu iness Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> PINK COPY: BUS. <br /> 1 Vl �1 L 1 4+[lJ 4/07 <br />