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Pn�,N COUNTY OF SAN JOAQUIN <br /> V, .0 OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue,Suite 300 <br /> a: a <br /> Stockton,California 95206 <br /> -- Telephone:(209)953-6200 <br /> Fax:(209)953-6268 <br /> 4�IFCRN <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS ESS AME ADDRESS(Facility Being Inspected) <br /> o s 7Lru & C /9'0 7 A14 v !'• . f ocklvoi Szo <br /> ACCOUNTA START DATE(New Bus) INSPECTION RRIVALTIME DE ARTURSPECTOR AME <br /> /2/62 � /!o E A/�/S' rsOjE IME INA& j6eZ <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible L., 5. Facility Map Complete and Accurate <br /> 2,Business Identification Page Complete&Accurate ✓ 6. Employees Familiar with HMMP <br /> 3.Business HMMP Complete and Accurate 7. Training Records Available <br /> 4.Chemical Description Pages Complete and Accurate 8. Unsafe Conditions Observed(see details below) .� <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> INSPECTION FOLLOW UP IN O MATION <br /> Corrective Actions Additional <br /> To Be Submitted By: 14 Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) I Buskss Representative(Signa COPY: OES <br /> e) <br /> WHITE <br /> f� OPY: BUSINESS <br /> 1210 REV 4110 <br />