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►5tul"! )"W COUNTY OF SAN JOAQUIN <br /> so. .co` OFFIGE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> c'°�iecaN:' Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS�tAME ADDRESS(Facility Being Inspected) <br /> ccr � ✓awU ,(�akii9 Co, me . 24,6 f. o✓ o <br /> ACCOUNT e START DATE(NeK Bus) I SP I DATE ARRIVAL TIME DEPA URE TIME I PECTOR NAME <br /> 99 3 �IP9 09Sa 1130 A?06ed_ 40 1-z <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 v <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 v <br /> 5.Training Records Available 10. Conditions that would hinder implementation of ✓ <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OFFINDINGS AND COMMENTS I + / + <br /> k - �. /✓l0. S i o S Lal.) ✓l'/O1✓' r� 0.T I't <br /> Q T t N'E- 0. � I •� � u v.� 0. -� '7'o r <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: m LL✓(,k L3 ZooS Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Na a and Title) Busi a Re r se ati a Signature) <br /> / WHITE COPY: OES <br /> �l/11 PINK COPY: BUSINESS <br /> REV 12M <br />