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0 0 <br /> COUNTY OF SAN JOAQUIN <br /> roll OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95205 <br /> Telephone:(209)953-6200 <br /> c4�lO'RN`a Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORINT <br /> BSINES NAME tyld'Qln akL ADDRESS Facility Being nM <br /> R211 Z' {��`r <br /> A COUNT# START DATE(New Bus) INSPECTION DATE I ARRIVAL TIME DEPARTURE TWE IN PE OR AM <br /> 2-1 --1 <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> 2.Business Identification Paee Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals a <br /> 3.Business HMMP Complete and Accurate K. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate <br /> 5.Training Records Available 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> NSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> o Be Submitted By: Referrals/Notes: <br /> 1 CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF I SPF4CTION RESULTS <br /> Business Representative(Print Name and Title) Bu 'ness Representative(Signature) <br /> . WHITE COPY: C�l.S <br /> j_ , , n'^ <br /> PINK COPY! BUSINESS <br /> k/A- `e REV 12108 <br />