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COUNTY OF SAN JOAQUI <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> c'`iRa""Y BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> TELEPHONE NUMBER <br /> BUSINESS NAME 1209J1 <br /> C Fla C-&T �/�7.3 <br /> BUSINESS ADDRESS(Facility Bei nspected Z�CODE <br /> ODE <br /> 9s z S� <br /> FIRE DISTRICT SP ON ATE ARRNALTIME DEPARTURE TIME INSPECTORN AGENCY <br /> 001 <br /> o 9 Z; <br /> a 09_d loos L <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 Complete and Accurate 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate t000, 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 or hinder im lementation of emerizencv Plan <br /> EXPLANATION OF F�NDINGSpAND COMMENTS L <br /> 4t_1.213 L/ (q 7 Or �[�r ��a� o. /X%C gscSL�� 1�10 r /to <br /> G, 49 Ir S tL/ iC / <br /> / rRhili /' r✓Q✓ /4 l��t� ✓ ✓- <br /> Q <br /> VQ ..t, <br /> jj <br /> ca o f /a CT- &w�++•tto �s wevZ fly e dye ilio <br /> d'LJ.4 ev cind o o. r -f- <br /> # 9 �a pec r t4Lt-)a f e P& /tet 6 <br /> �fYB •��/la.. r/olgxH� ?eL. k <br /> 4k i /0L O ?' �r�ow�iO�io'I� ✓fit... T. <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) [jSJ Ag y�SJ Envv Hlth OSHA %Fire Air Dist <br /> ?GS � All, 'e_ 4 7C /%G/ o"Oey <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> OES <br /> �ruM4bL� �V�✓� �� WHITE COPY: BUS <br /> PINK COPY: BUS. <br /> 1 Vtp <br />