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1 <br /> P�u'N COUNTY OF SAN JOAQUIN <br /> �o. .coG OFFICE OF EMERGENCY SERVICES <br /> a ROOM 610, COURTHOUSE <br /> ` 222 EAST WEBER AVENUE 1'2 e0_5' <br /> STOCKTON, CA 95V2-2709 <br /> 4`�FaR� BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS•PROGRAM INSPECTION FORM - <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 'Kiv"4 73 .2, v- <br /> FIRE DISTRICT INSPECFfON DATE ARRI AL TIVU DEFARTURE TIME" INSPECTOR NA.. , AG NCY <br /> :.t <br /> 1It,l i <br /> DOCUMENT REVIEW VF.S 140 FACILITY WALI�1MOU H YES NO <br /> 1.Business HMMP Complete and Accurate ✓ 6.Facility Map.Complete and Accurate f/ <br /> 2.Chemical Description Pages Complete and Accurate t/ 7.Chemical inventory Complete and Accurate V <br /> 3.Business Identification Page Complete and Accurate ✓ 8.Employee's Familiar with HMMP <br /> +4. HMMP/Map Easily Accessible to Employees V 9.Hazardous Materials/Waste Properly Labelled <br /> J10.Conditions noted that could increase risk of releas <br /> 5.Training/Exercise Records Available or hinder im lementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> w <br /> t4 17 14 4;�' AO -J oc� 44 <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 ❑SJ Env Hlth ❑OSHA Fire ❑ Air Dist <br /> .CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> _ WHITE COPY: OES <br /> ry d'1'b�f �_�i ft, L Com, `�CA ,`t&t PINK COPY: BUS. <br /> i' � 'tJ� 4/07 <br />