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'COUNTY OF SAN JOAQUI9' <br /> PARI" OFFICE OF EMERGENCY SERVICES <br /> 1a��o <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> �,�IFOpN`P BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> -7 MU - S7-v� 9s'zio <br /> FIRE DISTRICT INSPECTION DATE JARIUVALTIME DEPARTURE TIME I INSPECTOR NAMFIAGENCY <br /> Z 2— /7-.7e- © fY t—C-- E A/ / 0 CS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate ✓ 6.Facility Map Complete and Accurate <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 /> 10.Conditions noted that could increase risk of releas <br /> 5.Training/Exercise Records Available or hinder implementation of emergencylan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> A/47Z�5 TbC A_ A— ®l' 0--e- <br /> NOTE: <br /> L 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 /> `� - 08' El <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> S <br /> ,// A WHITE COPY: OES� t�� PCc-s16 6K ` X PINK COPY: BUS. <br /> M07 <br />