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Aul COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> m` 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 <br /> BU INESS N ADDRESS(Facilit Bein Inspected) <br /> tAtC6UNT ST TDA E(New Bus) I SPE2CCCI^OON DATE ARRIVAL TIME DEPARTURE TIME IN E R AM <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 /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPWVON RES TS <br /> usiness epresentanve Print a and Title) ature) <br /> t ' � WHITE COPY: US <br /> `,'�,7�7//` PINK COPY: BUSINESS <br /> REV t <br />