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• <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ug <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE 7 F6 <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS N E _,4-F& :L Mo� / la TELEPHONE NUly1��+ <br /> BUSINESS ADDR (Facility Being Inspected) A <br /> ZIP CODE <br /> — _�L 0 t ., '.�4,// ��2 <br /> FIRE DISTRICT pnSPECTON ATE 11 ARRIVAL TIN. DEPARTURE TIME INSPECTOR NAMEIAGENCY <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROU H YES NO <br /> 1. Business HMMP Complete and Accurate C�— 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate v 7.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 t/ 9.Hazardous Materials/Waste Properly Labelled <br /> 5. Training/Exercise Records Available <br /> 10.Conditions noted that could increase risk of release <br /> 11 or hinder implementation of emergency Ian <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> C TQ 7 <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) SJ Ag ❑SJ Env Hlth OSHA [:]Fire ❑ Air Dist <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usiness Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OE5 <br /> T(: Aw�n"AL' eC^ PINK COPY: BUS. <br />