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COUNTY OF SAN JOAQU117 <br /> i <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> " 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS N TELEPHONE NUMBER <br /> (3�0 (moi 31001-105 <br /> BUSINESS ADDRE (Facilit Being Inspected) ZP CODE `D <br /> 1 I <br /> EDISTIjICT INSPECIONDATE JARRIVALTIME DEPARTURETIME NA FlAGENCYo�SL�P <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate X 1 8.Employees Familiar with HMMP <br /> 4.HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/waste Properly Labelled <br /> 10.Conditions noted that could increase risk of releas <br /> 5.Training/Exercise Records Available or hinder implementation of emergency lan <br /> EXPLANATION OF. FINDINGS AND COMMENTS <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) E]SJ Ag ❑SJ Env Hlth []OSHA ❑Fire ❑ Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Re esentative(SZZ <br /> WHITE COPYJBUS. <br /> ��� tow( �� Puax coat: <br />