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COUNTY OF SAN JOAQUIN <br /> Pao N OFFICE OF EMERGENCY SERVICES <br /> r. ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> a`" STOCKTON, CA 95202-2709 <br /> P BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> B INESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility BeingInspected) ZIP CODE <br /> ?2L4 <br /> l� <br /> F DISTRICT INSPEON DA ARRIVAL TIME DEPARTURE TIME IN PECTORNA AGENCY <br /> 127 <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 /> 5.Training/Exercise Records Available 10.Conditions noted that could increase risk of release <br /> or hinder implementation of emergency lan <br /> EXPL_1NATION OF FINDINGS AND COMMENTS <br /> no On V\s <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) Business Represen tive(Signature) <br /> y,/ WBITECOPY: OES <br /> 419411 lez6e t� 1 6N v. / GLI A-if e' / PINK COPY: BUS. <br /> am <br />