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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ? ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS SNAME TELEPHONE NUMBER <br /> (A if ivl ' /t5 x'(03 - o9©a <br /> BUSINESS AD SS(Facility Being In cted) / ZIP CODE <br /> ee- q g s2/S_ <br /> FIRE DISTRICT INSPEC170 DATEARR ALTIME DEPARTURE INSPECTOR NAMEIAGENCY <br /> �36b /335 R�6�✓f �. t Z <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate ✓ 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate 8. Employees Familiar with HMMP c <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 10.Conditions noted that could increase risk of releas <br /> 5.Training/Exercise Records Available I or hinder implementation of emerizency 1lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> O .� y✓16L_ 0,2 $ . i S doa77.Dr'�yiBu C' OcJcLe <br /> 0152 Vj 04 ot,10 is, <br /> NOTE: All HMMP documents except for the Facility Map can be created and updated on the San Joaquin County <br /> HMMP Compliance Website at www.sjoesdata.org. Contact OES for user name and password. <br /> INSPECTION FOLLOW-UP INFORMATION <br /> Corrective Actions Must Be Submitted By Follow-Up Inspection Date Referral Actions <br /> (if appropriate) ❑SJ Ag ❑SJ Env Hlth [-]OSHA ❑Fire ❑ Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OSS <br /> A PINK COPY: BUS. <br /> \ ���. �� \ PINK 4/07 <br />