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f <br /> AM <br /> oPt�ulq COUNTY OF SAN JOAQUIN <br /> ' '•o� OFFICE OF EMERGENCY SERVICES <br /> ? 2101 E. Earhart Avenue, Suite 300 <br /> "• ` ` Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> �q•. :� <br /> Fax:(209)953-6268 <br /> �%FpPN <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUST SS NAMEDDRESS(Facility Piing Inspected) <br /> vv��vi Aqt' v►1 d <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE ARRIVAL TIME DEPARTURE,11MEINSPE OR AME <br /> U�(� to l0- aU sE/ t � d ,rt54 <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 <br /> Co✓✓P u t ve <br /> / fcd a mo ( o <br /> NSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> o Be Submitted By: W•' Referrals/Notes: <br /> ` CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usiness Representative(Print Name and Title) Businessepres alive(Signature) <br /> WHITE COPY: OFS <br /> PINK COPY: BUSINESS <br /> I 1r REV 17J <br /> 1 <br />