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Alk <br /> COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> C4�lF'O��`P Fax:(209)953-626$ �S ��30 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) Q <br /> AT&T MOBILITY ittgol S .`�' C 2 1 V of • <br /> A`CCOliNT# START DATE(New Bus) INSP ION DATE ARRIVAL TIME DEPARTURE TIME INSPECTOR AME <br /> 1 ZYO 7 . z Q I /2--1-M !6 1 ROBERT LOPEZ <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 5. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate oe <br /> 6. Employees Familiar with HMMP <br /> 3.Business HMMP Complete and Accurate 7. Training Records Available <br /> 4.Chemical Description Pages Complete and Accurate 8. Unsafe Conditions Observed(see details below) <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> NO cod/•-ec- / 0-4'-r �4'ee <br /> INSPECTION FOLLOW INFjDRMIATION, <br /> Corrective Actions Ply, Additional <br /> Submitted By: Referrals/Notes: <br /> 'OWLEDGEMENT O REVIEW D RECEIPT OF INSPECTION RESULT <br /> Business Represenbtat (Print Na> �and�Titl ) Business R res e (Sig ture <br /> J WHITE COPY: US <br /> �f PINK COPY: BUSINESS <br /> W 1 REV 4110 <br />