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PAu,y COUNTY OF SAN JOAQUIN <br /> �o.• ,�.co` OFFICE OF EMERGENCY SERVICES <br /> r. :Z 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> - - <br /> Telephone:(209)953-6200 <br /> • c �e• <br /> Fax:(209)953-6268 <br /> 4��FOPN HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> B SS NAME ADDRESS(Facilit Bn Inspected) <br /> ina <br /> ACCO NT# j START DATE(New Bus) 3P IOI�DATE A iL TIME DEPART E TIME IN PECCOR NA <br /> U <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 Page Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 10. Conditions that would hinder implementation of <br /> 5.Training Records Available Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION-R LTS <br /> Business Representative(Print Name and Title) Business Rep a native tore) WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> ( . ,:..__.... ,,,,, REV Ivor <br />