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COUNTY OF SAN JOAQUI <br /> OFFICE OF EMERGENCY SERVICES <br /> m ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE # 1, c� <br /> 3/ /3 <br /> • Cq�I�opN�► • STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS N'Af / / TELEPHONE NUMBER <br /> 1y ✓OS a7 e l a.lS I'n C • fC& `_- <br /> BUSINESS ADDRESS(Facility Being Inspected ZIP CODE <br /> 3030 S . <br /> � � � +0Co k-6VN qSZ/S <br /> FB2ED TRICT I INSPECAON PATE ARRIVAL TIME IDEPARTURET54E INSPECTORNA AGENCY <br /> (3 9//O/OP o <br /> DOCUMENT REVIEW YIES 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 and Accurate 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate ✓ 8. Employees Familiar with HMMP <br /> 4. IM MP/Map Easily Accessible to Employees ✓ 9.Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Available 0.Conditions noted that could increase risk of releas <br /> or hinder implementation of emergency lan <br /> EXPL_1NATION OF FINDI GS AND COMMENTS <br /> J c i A' <br /> i�7✓o�Tt� / <br /> AG / <br /> tldml L 677 > <br /> ell- <br /> O 2 <br /> Ae_ w..a- eGCIC IP'.e. -t- <br /> Lr In T 2 <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 /> S ¢ �.u., E] <br /> ACKNOWLEDGEME T OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business eenta i e(Print ame and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> RQ p Ltif _,�1 5 PINK COPY BUS. <br /> 'D IOW V07 <br />