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aPQuly c COUNTY OF SAN JOAQUIN <br />?''''•�� OFFICE OF EMERGENCY SERVICES <br />a: <br />y2101 E. Earhart Avenue, Suite 300 <br />Stockton, California 95206 <br />Telephone: (209) 953-6200 <br />Cd�1 FO'RN�P Fax: (209) 953-6268 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NAME t� ^ <br />we VI I ,,t cI <br />ADDRESS (Facility Being Inspected) <br />2& 2t m4qcM tf d <br />ACCOUNT k <br />LP5 <br />START DAT (New Bus) <br />✓ <br />INSPEETION DATE <br />1 15�- 17----" 112 <br />ARRIVAL TIME <br />3-0 <br />DEPARTURE TIME <br />.W <br />INSPECTOR NAMFK <br />INSPECTION RESULTS <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />. 1. HMMP/Map On Hand and Easily Accessible <br />6. Facility Map Complete and Accurate <br />2. Business Identification Page Complete & Accurate <br />7. Presence of Non -Listed Regulated Chemicals <br />3. Business HMMP Complete and Accurate <br />8, Employees Familiar with HMMP <br />3. Chemical Description Pages Complete and Accurate <br />9. Hazardous Materials/Waste Properly labelled <br />5. Training Records Available <br />10. Conditions that would hinder implementation of <br />Emergency Plan or increase risk of release are absent <br />EXPLANATION OF FINDINGS AND COMMENTS <br />4 7. OL d� (yvew <br />coo' jm <br />Gt �t ahu, tdc'nq <br />61 <br />INSPECTION FOLLOW UP INFORMATION <br />Corrective Actionsn <br />o Be Submitted By: — 11 ol <br />Additional <br />Referrals/Notes: / <br />CKNOWLEDGEFiENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business prese tive (Print Name and Title) Business Represe Live ( lgnature) <br />1 \�� PINNK COPY: BHITE COPY: USINESS <br />REV 12/W <br />