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COUNTY OF SAN JOAQUIN"' <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> <<Foa BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> u �Le P. zzA <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 2fT/C/ -7-- A-2C Lnl 70GP--n­c 011 ys2/ 5 <br /> FIRE DISTRICT INSPECTION DATE AR�RI}(AI,��IE DEPARTURE TIME INSPECTOR NAME/AGENCY <br /> 2-0- 0-7 - JJ 14,jenf-i— �tc r—r/ ©tom <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 ccurate 7.Chemical Inventory Complete and Ac <br /> 3.Business Identification P omplete and Accurate 8. Employees Familia MMP <br /> 4. H MIP/Ma sily Accessible to Employees 9.Haz aterials/Waste Properly Labelled <br /> 5. ming/Exercise Records Available 10.Conditions noted that could increase risk of releas <br /> or hinder implementation of emergency lan 11 <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> 4/00 /fir /,"0, A I <br /> Zso /6� �E��uM X 2 �r�,.�r��►c..s <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 /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Bus' ss Rep sentat' (Signature) <br /> WHITE COPY:.OES <br /> PINK COPY: BUS. <br /> �°Yl E Sid Qn S t/v1 4i0; <br />