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• <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> q ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE ?et/2-77,P <br /> STOCKTON, CA 95202-2709 <br /> rR�fFOR�`p BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSIN S / <br /> S NAME TELEPHONdENUMBER <br /> (/ r W 2- <br /> BUSINESS <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 9 0 4 o� �H ,��. 5 �� gsTZa 91 <br /> FIRE DISTRIC ff INSPECTION ATERRtVAL TfME DEPARTURE TIME INSPECTOR NAMEIAGENCY <br /> `o�► CIS' !�!4 !.2 Z-Sr ,�� -,— O <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGIf 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 t� <br /> 3.Business Identification Page Complete and Accurate f/ 8. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> / 10.Conditions noted that could increase risk of releas <br /> 5.Training/Exercise Records Available A/' or hinder implementation of emergency Ian <br /> EXPL_1NATION OF FINDINGS AND COMMENTS <br /> - <br /> C© O1e-,C i4o <br /> viaw <br /> NOTE: All IIMMP 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) 1:1 SJ Ag ❑SJ Env Hlth OSHA Fire Air Dist <br /> 1 -7/ 2-609- ❑ <br /> 6,CKNOWLEDGEMFiNT O VIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Re esent ve(Pr' t Na e a d Title) Business Repres ativ ( ature} <br /> WHITE COPY: OES <br /> PINK COPY: BUS. <br /> 4107 <br />