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oPAuly COUNTY OF SAN JOAQUIN <br /> '•o� OFFICE OF EMERGENCY SERVICES <br /> Q` 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> �'• <br /> Fax: (209)953-6268 <br /> q<]FoaN�� <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME .. ADDRESS(Facility Being Inspected) <br /> J P fQ/�GTia�,/dr -(� 3S/U S= <br /> ACCOUNT# START ATE(New Bus) INSPECTION DATE ARRIVAL TIME DEPARTURE TIME I SPECPOR NAME <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YESNO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate ScG <br /> 2.Business Identification Page Complete&Accurate S6F resence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate -,6 ,. W. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate S� E(e . Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent l <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> si � l�< <G G1 ,b a �� s �w s io.�✓ <br /> i,:� Se�o�✓11 �T�� ��i.�et�6wti6 �.ro�TOG��o6a�li��Cirr/v..� <br /> 6c2Yori <br /> 3 iY� f.�� tiu,vtdcr,L 6 ry6 8lr�in.��J ,� L L 8K rcf'Odl�c�i l�. <br /> y <br /> �ll/•��i�D/f✓6 OC.CIiiG,O.t�Cl�f, <br /> CAW,- <br /> INSPECTION FOLLOW UP INFORMATION <br /> orrective ActionsAdditional <br /> ToBe Submitted By: �!� Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION POULTS <br /> Business Representative(Print Name and Title) Busines a esenta 've(Sign ure) <br /> ✓ WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> REV 12/08 <br />