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AOL <br />Alk <br />u y COUNTY OF SAN JOAQUIN MW <br />�.• � ,oma OFFICE OF EMERGENCY SERVICES <br />Q 2101 E. Earhart Avenue, Suite 300 <br />Stockton, California 95206 <br />'• ' '- Telephone: (209) 953-6200 <br />Fax: (209) 953-6268 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME <br />ADDRESS (Facility Being Inspected) <br />-7-Zuc-K Cg- <br />. .?3 - /17-9 s z©.r <br />ACCOUNT # START DATE (New Bus) <br />INSPECTION DATE <br />ARRIVAL TIME DEPARTURE TIME <br />INSPECTOR NAME <br />z i <br />I <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 />I c rate <br />2. Business Identification Page C�� <br />7. Presence of Non -Listed Regulated -Chemicals <br />3. Business HMMP Co e and Accurate <br />8. Employees 'iliar with HMMP <br />4. Chem' escription Pages Complete and Accurate <br />azardous Materials/Waste Properly Labelled <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 />�G ucT[ CH O/L � SS— Gri�LO/�CS <br />I USG! ?T C- O <br />US r7f-,p-t_ CL-05A-nrE9-- <br />VO <br />Z.TO 2 <br />T 0/(- —z� 17/90 <br />Nle -z1/ Oi � -�? 3 c� r� G-•9T--� nes <br />e Awn <br />63e? P & 4-- Zo-O C -OL_ --O At <br />GPM1-'r`re3�1 ti l� <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions <br />Additional <br />To Be Submitted By: <br />Referrals/Notes: <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTIONARESULTS <br />Business epresentative (Pr' t Name and Title) Business e t e CSig t re) <br />WHITE COPY: OES <br />PINK COPY: BUSINESS <br />oe <br />