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I <br /> 0-9b z <br /> PgUlN COUNTY OF SAN JOAQUIN <br /> so. .co` OFFICE OF EMERGENCY SERVICES <br /> y` 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> -_ Telephone:(209)953-6200 <br /> Fax:(209)953-6268 <br /> �1POR� <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS NESS A RRES Faci "ty Bei g Inspected)Ceoq <br /> ACCO[}{d'I'k START DATE(New Bus) I PECFION DATE AR IIIVAAL TIME DEPARTUR TIMEI SP O NA <br /> i -(01 cam, <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 /> mn 0I1 I l �Aff e <br /> t <br /> u + 1 <br /> INSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> o Be Submitted By: 2 Referrals/Notes: <br /> CKNOWLEDGEMENT OV REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usiness Representative(Print Name and Title) Business Representative(Signature) <br /> Iln L.I_ PINK COPY: BUSINESS <br /> REV 12/08 <br />