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►a tl!r COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> Fax:(209)953-6268. <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM %S <br /> NESS NA E ADDRESS(Facility Being Inspected) <br /> �✓ C_ . g87 C o ve. " <br /> ACCOUNT# START TE(New TI <br /> SP ION ATE ARRIVALTIME DEPARTURETIME INSPE ORNA E <br /> 153© 1 (0 2t5 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 <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 /> © L' Q © o <br /> NSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> o Be Submitted By: Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usmess Representative(Print Name and rte) Busm s Representative(Signature) <br /> p WHITE COPY <br /> 5� PINK COPY: BUSINESS <br /> REV 17108 <br />