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a� N COUNTY OF SAN JOAQUIN <br /> aal�a�o OFFICE OF EMERGENCY SERVICES <br /> r.' 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> • �I `' `�• Fu:(209)953-6268 <br /> s 6'R`' HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> ADDRESS(Facility Being Inspected) <br /> BUCa( +v�. f e e I S+q t` Ca r n e [ ` 57- <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE JARRIVALTIME DEPARTURE IME INSPECTOR NAME <br /> 0 ;L-V Ile, —tO6 Z ec 1 [ t �j Iia r t <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 Vif,, 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 /> g Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> - (e/L&c, d �ur� ✓� Q �w <br /> Lei. - <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: �� `- �d Referrals/Notes: <br /> ACKNOW,LEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> mess eprentative and Title) Bu ' t e(signature) <br /> WHITE COPY: OFS <br /> 01 PINK COPY: BUSINESS <br /> REV 12108 <br />