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Pp U t N COUNTY OF SAN JOAQUIN <br /> o• c OFFICE OF EMERGENCY SERVICES <br /> a2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> _= Telephone:(209)953-6200 <br /> C�<<FORN`P Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> w'j -rW3c-c I 2-R-/9 AV Ae-cN Lam/ <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE I ARRIVAL TIME DEPARTURE TIME JINSPECTOR NAME <br /> //I-s' �c_ E.✓ <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 5. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 6. Employees Familiar with HMMP ✓ <br /> 3.Business HMMP Complete and Accurate 7. Training Records Available <br /> 4.Chemical Description Pages Complete and Accurate 18. Unsafe Conditions Observed(see details below) <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> 02X6.2. G✓/`rH To CO r"f/-1 L 6�-r-6- i¢ -'C9'2tLcY 7-C-' S•/71L-r- <br /> 1-fA-4. 4,1,k;- At-y o 6- <br /> D <br /> til S YX D u <br /> INSPECTION FOLLO'vN"UP INFORMATION <br /> Corrective Actions � Additional <br /> To Be Submitted By: 7— �� Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business esentivs me and Title) Busines ep se tative(Signature) / <br /> CC��//�L��,,moi (/ WHITE COPY: OES <br /> 44 I PA;4L PINK COPY: BUSINESS <br /> °� �✓ !3 REvano <br />