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COUNTY OF SAN JOAQUIN <br /> aaP ~�o� OFFICE OF EMERGENCY SERVICES <br /> 2` ? 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 /> BUSINESS NAME TELEPHONENUMBER <br /> GrnOC&Al O/C 209- V77-,&o <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 4/ .f Ale. i•JG- er. SrVc*-ro✓ 9.fLo7 <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME I INSPECTOR NAMF/AGENCY <br /> ZZ 1 ?-/S- 07 1 /0.•4,10 Z0A.-e'LL- A-L&`h/ <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate VIle6.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 I� <br /> 4.HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Available /10.Conditions noted that could increase risk of release <br /> l/ or hinder implementation of emerpency plan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> 7 O, — O7- UC 1,41'rr 01 e- /-r o^ ii✓G <br /> F4_14 iN UA b o IL FULL SS C"4&- '17,e4MS <br /> OF f}STe- Of4L 4Af6OA/E' fcfLL f ,L ugcccT v,-ri4 <br /> o uDc. F ,a e- / p -r . ,CtrDAW <br /> y ^ A/o PCrM/ on! sar A/em 7M Aceeidi coPY o.✓ sort <br /> S' / 10 7ZZW,11A/!r te-COA:7s <br /> — ^fAjO Mrte rr c M c A Tro <br /> e_WM9 � Nd-E-'D 70 se- ccose-'YLj 44P Te /9,Ce14e'A1r- So0lLf 4a-4r-. <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) 11 SJ Ag ❑SJ Env Hlth []OSHA Fire ❑ Air Dist <br /> 27 ! 07 8=29-07 ❑ <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Represe=(Sign <br /> WHITE COPY: OES <br /> PINK COPY: BUS. <br /> 407 <br />