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r� <br />Alk <br />COUNTY OF SAN JOAQUIN <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 />GiFCRN <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME <br />NAME �p/��i y <br />AD?DRESSSS7(Facility Being Inspected) <br />ACCOUNT # <br />to t9 <br />START DATE (New Bus) <br />.�/,0 <br />INSPECTION DATE <br />of <br />ARRIVAL TIME <br />IDEPARTURE TIME <br />9S/d.�.� <br />INSPECTOR NAME <br />/Q�l .r�'Cdy <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES YO FACILITY WALK THROUGH YES NO <br />1. HMMP/Map On Hand and Easily Accessible <br />ill6. <br />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 Accurate <br />V1 <br />9. Hazardous Materials/Waste Properly Labelled <br />5. Training Records Available <br />.Conditions that would hinder implementation of <br />Emergency Plan or increase risk of release are absent <br />EXPLANATION OF FINDINGS AND COMMENTS <br />�f/�t c . 6o<rrd.G s'r ria.✓ s� lorrl�� ca <br />�D,wei� �.cc 7.sies' ,S>�GE�'Q,F/ �.�.fP �J•e�6�/J/.r�.L�G7' <br />i0,fi k /S7� tib' G o 1 <br />atm i�.1�/ey✓� �T.t�i.�. t�.i G y ,t; a �sd..a� C/i�a � /�,odl Qin <br />INSPECTION FOLLOW UP INFORMATION <br />orrective Actions <br />jftSubrmllcd By: 7T Q <br />Additional <br />Referrals/Notes:/4/11(w;�r' <br />ALOKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPEC ION RESULTS <br />gsiness Repre entattvc (Print Name nd Ttle) Bust ess Representative ignature)WHITE COPY: OES <br />y� PINKCOPY: BUSINESS <br />C. 1t1 I' -/OF <br />0474ic-.Q — L1V <br />