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Qu,N COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> Q' a 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> • c ., w• Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> M <br /> 1 y�rES AME ADDRESS(Facility Bein Inspected) <br /> 4_ lel\'vin G� 2 , r <br /> ACCOUNT START DATE(New Bus)JINPECTTON DATE ARRIVALTIME DEPARTURE TIME SPE OR AM <br /> 1 <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 Property Labelled <br /> 5.Training Records Available 10. Conditions that would hinder implementation of <br /> 8 Emergency Plan or increase risk of e=on <br /> absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> Y> 1\ Hal <br /> 01M- <br /> Zoo . <br /> uW vie, <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions n „ Additional <br /> l'o Be Submitted By. (� Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIVW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Sign) COPY: OES <br /> 4rrE <br /> K COPY: BUSINESS <br /> gMnjen Lf CA rREV lv <br />