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pq��N COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue, Suite 300 / <br /> Stockton California 95206 l z o�J 46 9—O G 2 5 <br /> Telephone:(209)953-6200 �` <br /> �'dti k aa`P:• Fax:(209)953-6268 �v 2-03` �3 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM S <br /> BUSINESS NAM ADDRESS(Facility Being Inspected) <br /> G-) - © 20Z,S LJ. <br /> ACCOUNTT## START DATE(New Bus) INSPECT ON TE ARRIVAL TIME DEPARTURE TIMEIN{SPEgTOR N <br /> O-C <br /> 101241 s / 00 )20b_,e :2Z <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible V 5. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 6. Employees Familiar with HMMP <br /> 3.Business HMMP Complete and Accurate 7. Training Records Available <br /> 4.Chemical Description Pages Complete and Accurate 8. Unsafe Conditions Observed(see details below) <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> ✓�L � � COH 2r �- �udi� -¢.3J �H ct eve <br /> d i -Sr <br /> �c <br /> 5 cd (o h v :to - <br /> ( d r _ <br /> x -A- -7s' - <br /> D � c tcsrneZJ c CL -e-r Lo ev <br /> 2v- : 0 eaJ w 0j e..- c L C, . <br /> S3 5 . R �t, e <r w4- <br /> CIO C.� o ZO <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: ,A Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECED'T OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) >tg9mlauve(Signature) _ <br /> �V �,miGa. /S��C1v15 ev PINK CCOPY: OES <br /> OPY: BUSINESS '. <br /> REV azo <br />