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p4Ul�y COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />a ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE <br />�... , - ..,P STOCKTON, CA 95202-2709 <br />`F; BUS. (209) 468-3969 FAX (209) 468-0273 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME <br />AT T mo 6/-4- A <br />TELEPHONE NUMBER <br />Boa - 63t'-2.Pz` <br />BUSINESS ADDRESS (Facility Being Insp cted) <br />ZIP CODE <br />FIRES DISTRICT <br />011-17 <br />INSP ON ATE <br />1 d-1610 d <br />ARRIVAL TIME <br />/ 2 ';�J- <br />DEPARTURE TIME <br />/ ZC -.r- <br />1 <br />INSPECTOR NAM//EIAGENCY <br />ZE%7�L� <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP Complete and Accurate <br />1/' <br />6. Facility Map Complete and Accurate <br />2. Chemical Description Pages Complete and Accurate <br />✓ <br />7. Chemical Inventory Complete and Accurate <br />aj <br />3. Business Identification Page Complete and Accurate <br />t% <br />8. Employees Familiar with HMMP <br />4. HMMP/Map Easily Accessible to Employees <br />41/' <br />9. Hazardous Materials/Waste Properly Labelled <br />1/ <br />5. Training/Exercise Records Available <br />„/ <br />10. Conditions noted that could increase risk of releasel <br />or hinder implementation of emergency lan <br />EXPLANATION OF FINDINGS AND COMMENTS <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 <br />Follow -Up Inspection Daly <br />(if appropriate) <br />Referral Actions <br />❑ SJ Ag ❑ SJ Env Hlth ❑OSHA ❑ Fire ❑ Air Dist <br />'KNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative (Print Name and Title) <br />' 1 <br />`1 y"TV Cs M66 bO 1-�L✓p V4L eX) "7_C' �►' C re <br />Business Representative (Signature) <br />WHITE COPY: OES <br />PINK COPY: BUS. <br />4/07 <br />