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.. 19.9. !!.. 47../ <br />.c.. <br />(7.F .116+ . .< i iii g# <br />Telephone: <br />COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES I i (-1 —7 0 <br />2101 E. Earhart Avenue, Suite 300 <br />Stockton, California 95206 <br />(209) 953-6200 <br />Fax: (209) 953-6268 <br />7 • -ii <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME ADDRESS (Facility Being Inspected) <br />: ;` 11- /17 , ;;,1 -' .,- , 14 el • l. , <br />ACCOUNT # START DATE (New Bus) INSPECTION DATE <br />--7,, (-- - 4., <br />) i ..) ,,, i. / i <br />ARRIVAL TIME <br />/ ../:) -.5 - <br />DEPARTURE TIME INSPECTOR NAME <br />f <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. HMMP/Map On Hand and Easily Accessible 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 />RECEIVED <br />APR 1 5 2nii <br />SAN JOAQUIN COD TY °FFICE OF EMERGE N • NCY SERVICP <br />--- <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actions <br />To Be Submitted By: , <br />Additional <br />Referrals/Notes: <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Bust ne.ss Representative,( Print Name and Title) Business Representative (Signature) <br />/ ._, , - / <br />, ,:.-- 1 c--/ , , <br />WHITE COPY: OES <br />PINK COPY: BUSINESS <br />REV -VW