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COUNTY OF SAN JOTQ'UIIV <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> _ 222 EAST WEBER AVENUE <br /> a ;�iPapN;: a STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> B INESS NA — TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility Being Inspected) Z COD$ <br /> N . �SG�a <br /> FIRE DISTRICT DATE A i AL TIME DEPARTURE TIME SP TO it N AGENCY . <br /> M 2 _/ <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate 6.Facility Map Complete and Accu <br /> 2.Chemical Description Pages Completecurate 7.Chemical Inventory Co ete and Accurate <br /> 3.Business Identification omplete and Accurate 8. Employees FapxkKar with HMMP <br /> 4. HMMP/Ma sily Accessible to Employees 9.Hazard aterials/Waste Properly Labelled <br /> 5.TrIng/Exercise Records Available 10. ditions noted that could increase risk of-release <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> �! t <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 /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Bust s Representative(Signature) <br /> WHITE COPY: BOFS <br /> US <br /> PINK COPY: BUS. <br /> C� l vA/L/ 1✓L— �Z w,'cGro„ y;1� l 4ro7 <br />