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satQui.y.c COUNTY OF SAN JOAQUIN <br /> �'•.o <br /> OFFICE OF EMERGENCY SERVICES <br /> art2101 E.Earhart Avenue, Suite 300 <br /> _ Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> c��iFOR`' P• Fax:(209)953-6268 <br /> HAZARDOUS MATERIALSPROGRAM INSPECTION FORM <br /> BUST�S NAME I ADDRESS(Facility Being Inspected) <br /> cE /�c�s LLC 5rCo9 E_ t Gs/ r-z�D <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTOR NAME <br /> Glo s 3-/9-ia 10.so �t <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 Accurat 7 9. Hazardous MateriaWWaste 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 /> t� :o c�lPGoyEt <br /> G✓f1O el—) 10A0 c¢—+ 'A Qe'S. <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usmess Representative(Print Name and Title) Busmen Representative(Signature) <br /> WHITE COPY: OES <br /> a `. a PINK COPY: BUSINESS <br /> v REV 11108 <br /> f <br />