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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a 1 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> - `- Telephone:(209)953-6200 <br /> C4Ci F O R��P Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM 6, <br /> BUSINESS N ME // s ADDRESS(Facility Bing In �e�/ f• 6-t <br /> A CO}ANT# START D TE(New Bus INSP ION D TE ARRIVAL TIME DEPARTURE TIME INSPE OR N E <br /> Nev i� 2eoCp <br /> .212 2� Q9 //3S /ts6 /�( 4?--%- <br /> INSPECTION <br /> RESULTS <br /> WHMMP/Map <br /> UMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> n 0andAcce blc 6. Facility Map Complete and Accurifiete&Accurate 7. Presence of Non-Listed Reg ted Chemicals <br /> Pcurate 8. Employees Familiar HMMP <br /> rilete and Accurate 9. Hazardous M tals/Waste Properly Labelled <br /> 5.Training Record 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 /> �2v J` G'L/ 4r <br /> o © -� 7ZX /; <br /> 2 0 ciR 3-0 <br /> Mike Hibler <br /> Manager <br /> (209)983-0155 <br /> Fax(209)983-0211 <br /> mikehibler@southernwine.com <br /> 1918 Industrial Drive <br /> Stockton,CA 95206 <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 /> Busines, re ntative rint Name and Title) Business Representative(Signature) <br /> WHITE COPY: US PINK COPY: BUSINESS <br /> REV 12i0R <br />