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ECIVc Q COUNTY OF SAN JOAQUINI. c <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> Fax:(209)953-6268 <br /> RP <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS N E ADDRESS(Facility Being Inspected) <br /> G «-w 4qq <br /> ACCOUNT A START DATE(N Bus) INSPECTION DATE ARRIVAL T E DEPART E TIM INSPE OR NAME <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 /> vn � %c �r it ✓i <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: (� Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIE AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name i le) Business Representative(Signature) <br /> WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> REV I <br />