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Py�u, COUNTY OF SAN JOAQUIN <br /> so. .caG OFFICE OF EMERGENCY SERVICES <br /> P;. a 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> ' Telephone:(209)953-6200 <br /> v Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINES ME ADDRESS(Facility Being Inspected) <br /> te �� � <br /> ACCOUNT# START DATE(New Bus INSPECTION DATE� ARRIVAL TIME DEPARTU TIME INSP OR NAME <br /> / IU'l IU i O <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 01 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 171 1 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> ��.. mopAly 1 jCc Ct vI n f owt /�.. <br /> NSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> o Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usines presentative(Print Name and Title) Business Represen tive(Signature) <br /> WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> 2 REV 17!08 <br />