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►�u�N COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> "` ` " 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility Bein spected) ZIPCODE <br /> u _ 95209, <br /> FIRE DIST, CT JINSPECFIONDAffJARRNAI]TINAE DEPARTURE TIME PECTOR N GENCY <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Co a and Accurate 7.Chemical Inventory Complete a ccurate <br /> 3.Business Identification a Complete and Accurate 8. Employees Familiar HMMP <br /> 4. FINIMP[MaP2911y,Accessible to Employees 9.Hazardous rials/Waste Properly Labelled <br /> 10.Co ' ons noted that could increase risk of releas <br /> 5.Trai xercise Records Available r hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> C l)� <br /> NOTE: All HMMP 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) ❑SJ Ag ❑SI Env Hlth ❑OSHA ❑Fire ❑ Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and <br /> Title) Business Repres ntative(Signature) <br /> Vlv' `'e �U -.� 1 �J I !ham WHITE COPY: OES <br /> 4/0 <br /> l/ PINK COPY: BUS. <br />