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Ink <br /> oPQuty COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a` j 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> ;FFax:(209)953-6268 <br /> Ope��� <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> Sew z-. l-I r-v 'x•32190 I 2/-9 y-.7 "cj x 99, sAc k/o 9s- z�S' <br /> ACCOUNT# START DATE(New Bus) INSPEf IO DATE ARRIVAL TIME DE ARTURE TIME INSP CTOR AME <br /> 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 t/ <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 0. Conditions that would hinder implementation of <br /> EXPLANATION OJ <br /> Emergency Plan or increase risk of release are absent <br /> �n1F FINDINGS AND COMMENTS <br /> 6- - dna <br /> I - PC s l c_ tz VVL 'e— 1 d1 p u lc <br /> o 02 e C9 1 ;/i •Q L/- <br /> INSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> To Be Submitted By: Q 26 0 Referrals/Notes: <br /> ' CKNOWLEDGEMENT OF IEVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> rA, PINK COPY: BUSINESS <br /> REV 12/08 <br />