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COUNTY OF SAN JOAQUIN <br /> 4...!y. <br /> OFFICE OF EMERGENCY SERVICES <br /> 2` y 2101 E. Earharl Avenue,Suite 300 <br /> Stockton,California 95206 <br /> •- Telephone:(209)953-6200 <br /> • (s ,. �P• Fax:(209)953-6268 / <br /> 'dticgaN HAZARDOUS MATERIALS PROGRAM INSPECTION FORM S{1&C_,< k <br /> BUSINESS NAME ADDRESS(Facility Being�/,II''ppspected) <br /> 'r <br /> ACCOURf# START DATE(New s) INSP N D E ARRIVAL TIME DEPARTURE TIME INsYE OR N <br /> 1311 ,21 /O 5 ISO �Q KDX'OR N e.z <br /> AYIE <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> t.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 /> 77 <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.Trainin Records Available 10. Conditions that would hinder implementation of <br /> 8 Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> INSPECTION FOLLOW UP INFOR ATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/N <br /> ACKNOWLEDGEMENT OF RE VIEW AND RECEIPT OFINSPECTI ESULTS <br /> us' s Representatt}�(Print Name and Title) Business epresen ( igna[ur WHITE COPY: OPS <br /> PINK COPY: BUSINESS <br /> �XYI�V YsW '^v ttEv twos <br />