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Auk <br /> aPr�uly COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a' 2101 E. Earhart Avenue,Suite 300 <br /> " Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESSAspect <br /> ADDRESS(Facility Being I ed) <br /> N ME <br /> Aq OUNT# START DATE(New Bus) INSPECTION DATE ARRIVAL TIME DEPARTURE TI I SPE O NA <br /> J�Z <br /> 03 <br /> Z INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> . 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> 2. Business Identification Page Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate x 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled X <br /> 5.Training Records Available ♦ 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> Own m CRI corr—ec� <br /> 5 rU�n \1 - o <br /> \0 <br /> W <br /> 6k F0 <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions <br /> ` Additional <br /> n // <br /> To Be Submitted By: v'/!�l —0 Referrals/Notes: <br /> CKNOWLEDGEMENT OF''REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usiness Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> Ow d PINK COPY BUSINESS <br /> y REV IYo8 <br />