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oPAuI!v COUNTY OF SAN JOAQUIN <br /> ? '•9� OFFICE OF EMERGENCY SERVICES <br /> 2r 2101 E. Earhart Avenue,Suite 300 <br /> Q: <br /> 2 <br /> a: :< <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> C4�IFGRNsP Fax: (209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM 9s^ZO <br /> BUSINESS NA E ADDRESS(Facilit Being Inspected) <br /> a ,-/iA1�r 3 3 vG. <br /> ACCOUNT# START DATE(New Bus) INSPE IO DATE ARRIVAL TIME DEPARTURE TIME IN E OR NA E <br /> o�3 9 P o /-5-k S-o ��r z <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 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS L <br /> e O nn L' u`'/' e---4 / /4. <br /> # 'Y � - Co rv7 � -�- G+-vlcl� �Lu�r % � � t'•e�' c ✓'i T�p�C -�. <br /> Cc. (-9 ;Ivy 0. C . <br /> t D G G(f�,'� <br /> NSPECTION FOLLOW UP INF RMA ION <br /> orrective Actions n Additional <br /> To Be Submitted By: `� Z Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usi epresentat ve(Print Name and Title) Business Representative Signature) <br /> WHITE COPY: OFS <br /> PINK COPY: BUSINESS <br /> 4� V aEv lvoa <br />