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a� N COUNTY OF SAN JOAQUIN <br /> �o OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS SNAME TELEPHONENUMBER <br /> acs 0V (o D7- 77�? <br /> BUSINESS ADDRESS(Facility Being Inspected ZIP CODE <br /> O ' keC/ 4"c/ 9SZo9 <br /> L__O /��e1 � 10FIRE DISTRICT I �7 `�RRIVA�_ D �A/ �C/ ME � _�p b�✓�RNAME/4GENCz <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate 6.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 Available 10.Conditions noted that could increase risk of releas <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS —1 <br /> n,A1 'L_ r <br /> Zo -t © ? ^? ? 8 7^ L' e <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) E]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 Re resentative Signature <br /> WHITE COPY:JBUS. <br /> INK COPY:^� <br />