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i <br /> �av►k COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> �`4 •.,.o•..N�P Fax: (209)953-6268 <br /> �fF R <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM S�Z <br /> BUSINESS NAME ADDRESS(Facility Being Inspected)' / <br /> ACCOUNT# ART DATE(New Bus) INSPECTION ATE JARRIVALTIME I DEPARTURE TIMEINSP CTpR NA <br /> /I 7 83 Z z.S io /43 d /U O06 �.a z <br /> INSPECTION RESULTS i <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 /> .l <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 HMIVIP <br /> 4.Chemical Description►Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 4 <br /> 5.Training Records Available 10. Conditions that would hinder implementation of cr <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> ` �' a O � �� cJ�~O'i.�. ut, X0+9 � /�,� � •�U7'�rOvl <br /> i� <br /> 1� <br /> i <br /> 1� <br /> • �a <br /> • �I <br /> l� <br /> INSPECTION FOLLOW UP INFO ATION �} <br /> Corrective Actions /� Additional <br /> To Be Submitted By: f ► Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS 1� <br /> Business Representative(Print Name and Title) BusinessRepre entative ignature) <br /> WHITE COPY: OES <br /> 1 PINK COPY: BUSINESS f <br /> PWLLr`�lG 1-1 C # RFV l?10 <br />