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COUNTY OF SAN JOAQUIN <br /> �oQ'coG OFFICE OF EMERGENCY SERVICES <br /> r. y ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> R...,. ;..�;;� STOCKTON, CA 95202-2709 <br /> �'�op BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> S ✓ E��v i -2©co z ms`s a 7e FS-0, -75--/3 <br /> BUSINESS ADDRESS (Facility Being Inspected) ZIP CODE <br /> y�o z7 _'ba Vt rI_t <br /> FIRE DISTRICT INSP IO,ti'DATE ARRIVAL TIME DEPARTURE TIME JINSPECTORNAME(AGENCY <br /> Z Z ��d�+9 <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate G. Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate 7. 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 Available10. Conditions noted that could increase risk of releas <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <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 Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> `l/ ' n-, PINK COPY: BUS. <br /> vG( a a/o7 <br />