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+;; . `- •a,qu�,,, c COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES f'1 <br />a 2101 E. Earhart Avenue, Suite 300 M <br />Stockton, California 95206 SAN JOAQUIN COUNTY <br />Telephone: (209) 953-6200 OFFICE OF EMERGENCY <br />C4�lFOR��P Fax: (209) 953-6268 SERVICE <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM r' <br />BUSINESS NAME <br />Ricci 'luS ,: <br />ADDRESS (Facility Being Inspected) <br />ACCOUNT # <br />START DATE (New Bus) <br />INSPECTION DATE I <br />ARRIVAL TIME <br />DEPARTURE TIME <br />INSPECTOR NAME <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />I. HMMP/Map On Hand and Easily Accessibletom. <br />5. Facility Map Complete and Accurate <br />2. Business Identification Page Complete & Accurate <br />6. Employees Familiar with HMMP <br />3. Business HMMP Complete and Accurate <br />7. Training Records Available <br />4. Chemical Description Pages Complete and Accurate <br />18. Unsafe Conditions Observed (see details below) <br />EXPLANATION OF FINDINGS AND COMMENTS <br />r r r P <br />j <br />INSPECTION FOLLONN" t -P INFORMATION <br />Corrective Actions / <br />To Be Submitted By: <br />Additional <br />Referrals/Notes: <br />CKNOWLEDGEMENT OF RE% 11 w I, RECEIPT OF INSPECTIO\ RE."I 1. IS <br />Business Representative (Print Nance and I itle) <br />Business Representative (Signature) <br />r /, <br />HITE COPY: <br />INK C 1(� <br />fhC( V REV 4j 11) <br />