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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> .... STOCKTON, CA 95202-2709 <br /> •�G/FORN`P BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ^ TELEPHONE ER <br /> 1 <br /> BUSINESS ADDRESS JFacility Being Inspected) ZIP CODE <br /> FIRE DISTRICT INSPECTION DATE 1,ARRIVA DSP RT JRE TBvIE INSPECTOR NAMEIAGENCY <br /> I` ll U I �. <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 Compl nd Accurate 7.Chemical Inventory Complete and Accura <br /> 3.Business IdentificationPogetomplete and Accurate 8. Employees Familiar with <br /> 4. HMMP/Map i y Accessible to Employees 9.Hazardous M s/Waste Properly Labelled <br /> 5.Tr ' ' g/Exercise Records Available 10.Con ns noted that could increase risk of releas <br /> r hinder implementation of emergency lan <br /> XPLANATION OF FINDINGS AND COMMENTS <br /> �)Q)MCCAMM — <br /> , <br /> 9 <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 RRSULTS <br /> Business pres a(Print Name and Title) Business tative(Signature) <br /> s WHITE COPY: OBS <br /> PINK COPY: BUS. <br /> V07 <br />