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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 4 ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> �..• , STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> T <br /> • ly X00--13Z-4,4,4=Z <br /> BUSINESS ADDRESS(Facility Being Ins ected) ZIPCODE <br /> 1,33 1 a tm L-.a-- -e- "d� ; q 2 Cf- ;L <br /> FIRE DISTRICT 1N ARRfVAL <br /> TUVMTINE INSPECTOR <br /> AGEN <br /> L© t I � O� ®� �01 /O/© <br /> DOCUMENRVIEW YES NO FACILITY WALK THROUGH <br /> YES NO <br /> 1.Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate 6/ <br /> 2.Chemical Description Pages Complete and Accurate 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate L/."* 8. Employees Familiar with HMMP <br /> 4.HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 10.Conditions noted that could increase risk of release <br /> 5.Training/Exercise Records Available or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> IP " A a'.LP ,✓ol r,2sr ✓o 42L OL e✓ct.c.c�04'10" Cw-r-c._ 0tv 2.- <br /> ✓1 O A- ko L') WN <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 /> 2 t 2-(:5 O a (if appropriate) SJ Ag []SJ Env Hlth OSHA []Fire [:] Air Dist <br /> .CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> PINK COPY: BUS. <br />