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PA�!N COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />a X 2101 E. Earhart Avenue, Suite 300 <br />Stockton, California 95206 <br />'• _' Telephone: (209) 953-6200 <br />cdUFeRN ° Fu: (209) 953-6268 C1 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME <br />r/12 iN�e_ U <br />ADDRESS (Facility Being Inspected) <br />//// 0. #.S per.' <br />ACCOUNT # <br />a% � <br />START DATE (New us) <br />INSP IO DATE <br />3- 7 a <br />ARRIVAL TIME <br />/3-90 <br />DEPART RE TIME <br />/ ,4r <br />INSPE OR AME <br />.�d�-/, Lye z <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />. 1. HMMP/Map On Hand and Easily Accessible <br />6. Facility Map Complete and Accurate <br />c� <br />2. Business Identification Page Complete & Accurate <br />V <br />7. Presence of Non-Listed Regulated Chemicals <br />3. Business HMMP Complete and Accurate <br />8. Employees Familiar with HMMP <br />4. Chemical Description Pages Complete and Accurate <br />9. Hazardous Materials/Waste Properly Labelled <br />5. Training Records Available <br />0. Conditions that would hinder implementation of <br />Emergency Plan or increase risk of release are absent <br />EXPLANATION OF FINDINGS AND COMMENTS <br />- Ca_ CL v ttW CI l R-0 U �L2 (2- o - - <br />10-0 Imo_ <br />LC <br />I SV1 n t-) C) <br />r/O ✓ i Ol-2 ✓ O T Q_V-1 T✓� i /L <br />LnJ <br />0 V- O L) - v\ V['� r_ © v� T l� C ✓" V%4 CL VC4-t (cam U ` <br />0.6 6- Ao ✓�. to d.% ✓ O -/- �cs . O ,e.r.f U <br />/� / /� <br />KJ lin is iy rl�,Gelbl�. <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions <br />to Be Submitted By: fit, ZV OI <br />Additional <br />Referrals/Notes: <br />ACKNOWLEDGEMENT OFEVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative (Pnn Name and Title) Busine ta[ive (Signature) <br />WHITE COPY: OES <br />PINK COPY: BUSINESS <br />