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o�puly o �✓ COUNTY OF SAN JOAQUIN <br /> ? `o� OFFICE OF EMERGENCY SERVICES <br /> 2` s 2101 E. Earhart Avenue,Suite 300 <br /> r: � <br /> Stockton,California 95206 <br /> _-- Telephone:(209)953-6200 <br /> C+riFCRN�' Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Bei Ins cted) <br /> T+f u <br /> ACCOUNT N START DATE(New Bus) INSPECTION DATE ARRIVAL TIME DEPARTURE TIME JINSPE&Oft NAME <br /> 2 -G,x <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 7. Presence of Non-Listed Regulated Chemicals <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 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> u t <br /> b--eiw re may <br /> INSPECTION FOLLOW UP INFOR TION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPEC ULTS <br /> Business Representative(Print Name and Title) Bust ss epr entative tg re) <br /> �_ ( --"--- -" WHITECOPY: OES <br /> f S' G S' Vv\� PINK COPY: BUSINESS <br /> REV Nott <br />