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¢Qul,y COUNTY OF SAN JOAQUIN <br /> ?4 '�9� OFFICE OF EMERGENCY SERVICES <br /> a 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> -`_ Telephone: (209)953-6200 <br /> c'P�iccR�'�P Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> B SI SS NA �t ADDRESS RESS <br /> J (Facilt Bein pdamJ <br /> ACCO START D E(New Bus) ECTION DA E ARRIVAL TIME DEPARTURE MEN <br /> PP M <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 X 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 /> "It - corrr c <br /> I vn MM or mai ) <br /> eef h) 5 <br /> yw ha I K71 ki 0 a <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective ActionsAdditional <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) WHITE COPY: OES <br /> i<' 'S PINK COPY: BUSINESS <br /> REV 12108 <br />