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COUNTY OF SAN JOAQUIN <br /> 14PR °oma OFFICE OF EMERGENCY SERVICES <br /> a ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> ..c�ciFoaa~.. STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> F u <br /> BUSINESS ADMESSFacility Being Inspected) / IPCO E <br /> a t/- 9SZ03 <br /> FIRE DISTRICT N DA' A ALTIME DEPARTURETIME INSPECTORN AG NCY <br /> 7ECTI <br /> DOCUMENT REVIEW YES O FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate M 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate VrI.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate 8. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Availableonditions noted that could increase risk of release <br /> or hinder implementation of emerizencV Wan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> 2 - T vto�i cr -e- (av v <br /> 1 I <br /> wt,tx S w x �LdL�C 2RS C G eS , <br /> l(q CjO� bn to 0 <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 DES 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) ❑SJ Ag []SJ Env Hlth []Fire �OSHA Air Dist <br /> 00 <br /> [-k..C.JM El <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> L c WHITE COPY: OES <br /> 7_9l_ i ��/t N� �{5 f(�GLC /C Mna1 ,/, PINK COPY: BUS. <br /> IFJ l ( ' 6F° 4/07 <br /> 1 <br />