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We <br /> oPgUtty C COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> _ ? 2101 E.Earhart Avenue, Suite 3001 <br /> a: a <br /> Stockton,California 95206 <br /> -- <br /> Telephone:(209)953-6200 <br /> 0 <br /> 4(.iFO* Fax: (209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> B I NA I ADDRESS(Facilit eing Insp ted) <br /> ACCOUNT# START A E(New Bus)JINSPECTION DATE JARRIVALIMPE 13811AKTURE TIME IN PE O NA <br /> NSPECTION RESULTS <br /> DOCUM NT REVIEW YES NO FACILITY WALK THROUGH NO <br /> 1.HMMP/Map On Hand and Easily A ssible 5. Facility Map Complete and Accurate <br /> 2.Business Identification Pa omplete&Accurate 6. Employees Familiar with <br /> 3.Business HMMP plete and Accurate 7. Training Reco vailable <br /> 4.Chemical scnption Pages Complete and Accurate 8. Un Conditions Observed(see details below) <br /> EXPL ATION OF FINDINGS AND COMMENTS <br /> OR MANt2Z <br /> 1 <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION SULTS <br /> Business Representative(Print Name and Title) mess Repr a ve t lure) <br /> WIII'I'E COPY: OES <br /> �C�f� D 2 ��V���VU PINK COPY: BUSINESS <br /> v �V Flo <br />