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LS!NA <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 /> Fax:(209)953-6268tHAZARDOUS MATERIALS PROGRAM INSPECTION FORM ,L'tS2 O �fDDRESS(FacilityBeingInspected) <br /> ORT DATE(New Bus) INSPECT N D E ARRIVAL TIME DEPARTURE TIME INSPE R N E <br /> r; ! 1200 Z� 0 8 !2-(5 S •z � <br /> NSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THRO GH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Ace to <br /> 2.Business Identification Page Comp] &Accurate 7. Presence of Non-Listed Re ated ChM <br /> 3.Business HMMP Complete a Accurate 8. Employees Familiar th HMMP <br /> 4.Chemical Description ges Complete and Accurate 9. Hazardous M rials/Waste Properly 5.Training Records Available 10. Conditions at would hinder implemEmergency Plan or increase risk of r <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> Z z <br /> L 47s, k <br /> �C ZSO c a to vl EtJ <br /> 4-u,, k- <br /> C_ /10 1 o o k- <br /> a i <br /> x s /(darL r e <br /> NSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> o Be Submitted By: Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usmess Representative(Print Name and Title) Busl ess RepresentauW (Signature) <br /> WHITE COPY: OES <br /> o-1, � �a� t �( i p PINK COPY: BUSINESS <br /> Vt � REV twos <br />