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COUNTY OF SAN JOAQUI <br /> aDaul"' OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> a... . STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> �ldS 6VA.1 !6c` LGt 6_08 <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> FIRE DISTRICT INSPECTION DATE JARPIVALTIME DEPARTURE TIME INSPECTOR NAMEIAGENCY <br /> ,L12GI� <br /> DOCUMENT REVIEW YES O FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate � Facility Map Complete and Accurate 5 <br /> 2.Chemical Description Pages Complete and Accurate Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate 8. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Available 10.Conditions noted that could increase risk of release <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> a�o-s GG 86 OdGBt6o F or v9 �/!/if/�t6L✓t� o�,�T S�Y/ls <br /> .yam <br /> 7:rd8 '� ,vww�cd" a.v <br /> �� .�a�Es,/G',6P�t„�.a!✓'.tae6' ��%L./�) � c-�c..�.Ccur„zr�¢s/o�� <br /> 6 �cilz m �..ity 6.I.� ���•t//Xil�.� ��.� •�•�-off <br /> .1/y,�lriG �a-r.9iyifi�,✓a�G �u� fi GoG�i®.�.� o..� � 40e, �.va <br /> f.�Cll N�1�OIIi/j/i�o'L�it.eS�it.Cf�/+^'�i�f GlalG /��O/•�/1.9iv <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 Follow-Up Inspection Date Referral Actions <br /> (if appropriate. ❑SJ Ag ❑SJ Env Hlth ❑OSHA ❑Fire ❑ Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and T�)� � Business Representative 'gnature) <br /> X HITS COPY: OES <br /> PINK COPY: BUS. <br /> 4107 <br />