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L I �5I <br /> COUNTY OF SAN JOAQUI <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> cq�iFaRa*� <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Faci ity Being Inspected) ZIP CODE <br /> FIRE DISTRI IN ECTION DATE ARRIVAL.TIME DEPARTURE TIME INSPECTOR MEIAGENCY <br /> I� Z ]�' u -OGS <br /> DOCUMENT REVIEW YES NO FACH-ITY 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 8. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous MaterialslWaste Properly Labelled <br /> 10, Conditions noted that could increase risk of release <br /> 5.Training/Exercise Records Available or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> 4Hy1y6h YWA2 k) bt LC •+h <br /> _ I <br /> �iM 9-Z2,08 <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 1:1SJ Env Hlth OSHA ©Fire Air Disk <br /> 4 } <br /> 4COW—L'EDGEMENT OF REVIEW AND RECEIPT OF INSPE TION RESULTS <br /> Business Represent tive(Print Name and Title) B siness Representative(Signature) <br /> �- WHITE COPY: OES <br /> c ` • PINK COPY: BUS.' <br /> J1 4/07 <br />