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COUNTY OF SAN JOAQUIN <br /> ? ' '•oma OFFICE OF EMERGENCY SERVICES <br /> r` `a 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> S{�/FaaN:P Fax: (209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> STO4 Nra /~ EllI,.S <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTOR N641E <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 6 10 Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release areabsentl V10, <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> 12 s sfd' L6cdrr� d 6 ��ld cr c v� l A <br /> 6ir�GoGS - /G2iw� — Ina <br /> 6Ga✓dnJ <br /> c�6vi Ea' <br /> ,f.�ni.✓iw cr�� w G!. �BS6s✓T v�� �lr�iJlG o.� �x /O <br /> INSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> Submitted By: Referrals/Notes: /f.Vir/ee <br /> NOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Repres ntative(Print Name a Title) Bus ess Representatrve.(Signature) <br /> (� WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> REV IVOa <br />