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COUNTY OF SAN JOAQUIl\ <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> H: 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> u --7—AL P, z_2-A Z09- 77 - S-'Z7� <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIPCODE <br /> 2Fr/y -r- c" Ltd S7-0 C_ ysZ/ 5 <br /> FIRE DISTRICT INSPECTION DATE ARR <br /> /�AY E DEPARTURE TIME I INSPECTOR NAME/AGENCY <br /> 2- 0- 0-7 - �v,v ez� AL-en'l Z (9 6_3 <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 Famili MMP <br /> 4. HMMP/Ma stly Accessible to Employees 9.Haz aterials/Waste Properly Labelled <br /> 5. tning/Exercise Records Available 10.Conditions noted that could increase risk of release <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> ZSO /6s AlE&iN.y X 2 c),-4iA13 C-'Ks <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 /> I SM QY t 5 CN\ L 4/07 <br />