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Ak <br />Ah <br />nau .M• COUNTY OF SAN JOAQUIN Wr <br />OFFICE OF EMERGENCY SERVICES <br />Q` 2101 E. Earhart Avenue, Suite 300 <br />Stockton, California 95206 <br />'• ' �= Telephone: (209) 953-6200 <br />C,�iFO•RN�' Fax: (209) 953-6268 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />B :29 N <br />V _A <br />ADD SS aci " Bei g In cted) <br />ACC # <br />1l <br />S RT DA E (New s) <br />�E A <br />I PECTION DDOeV Py <br />(PECTION <br />RI L TIME <br />DE ARTUR TIME <br />IN E ORNAM <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. HMMP/Map On Hand and Easily Accessible <br />6. Facility Map Complete and Accurate <br />2. Business Identification Page Complete & Accurate <br />7. Presence of Non -Listed Regulated Chemicals <br />3. Business HMMP Complete and Accurate <br />8. Employees Familiar with HMMP <br />4. Chemical Description Pages Complete and Accuratc <br />9. Hazardous Materials/Waste Properly Labelled <br />(/ ! <br />N <br />5. Training Records Available <br />10. Conditions that would hinder implementation of <br />Emergency Plan or increase risk of release are absent <br />EXPLANATION OF FINDINGS AND COMMENTS <br />1 <br />NSPECTION FOLLOW UP INFORMATION <br />CCorrective Actions <br />o Be Submitted By: <br />Additional <br />Referrals/Notes: <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPEC N RESULTS <br />Business Repre tativ ( riot ame Id <br />/{ Y <br />y / <br />Title) Busm <br />Sfs R ese ave (Signature) <br />WHITE COPY: OES <br />PINK COPY: BUSINESS <br />REV 17108 <br />V <br />