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Alk A& <br /> PpU1N 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 /> Cq�tFC,M1N�' Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME I ADDRESS(Facility Being Inspected) <br /> cv Er✓Fve�-4 Z (0 27 7 V SZ07 <br /> ACCOUNT# START DATE(New Bus)1INSPECTION DATE I ARRIVAL TIME IDEPARTURE TIME INSPECTOR NAME <br /> -13 1 1 y 3o I I A - <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 f 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 f <br /> 5.Training Records Available10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent ✓ <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> AA-^l nr 7`o r /4/Fr.JTF'init� /4i� t .Sn/c3' <br /> '#Z qlr4gCTPO>3ro r coin Pc c iZ <br /> '¢S- .3usi.J c`3 .�/cz--mss �-•0 7�ea.,.f (-��-(P�p�rrC off' O�c�4-� <br /> T �Aac A c oP Y o f T7f c a I nl tnr �c t �ZJS ou <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions -2Additional <br /> To Be Submitted By: - Z - O c/' Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Repr sentative(Signy[ ate) <br /> a C-rP MPt111 A�-�.i r p�►l�u�n° u .�-✓ ///'�✓ WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> REV 12108 <br />