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%.W COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue,Suite 300 <br /> a: a <br /> b: tK <br /> Stockton,California 95206 <br /> ' Telephone: (209)953-6200 <br /> �`•{• ........ei:�• Fax:(209)953-6268 <br /> /POR <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSIN SS NAME ADDRESS(Facility Being Inspected) <br /> ,.J Ln/ <br /> ACCOUNT M START DATE(New Bus) INSPECTION DATE ARRIVAL TIME IDEPARTURE TIME INSPE OR NAME <br /> 2fl Z S�/Z <br /> -05, /5/,T0 <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 . 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 /> o Be Submitted By: s zlo _ p9 Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> x1./ C/�6 o 607 �Gtll�C r� PINK COPY: BUSINESS <br /> w+r' <br />