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Ah <br /> Q�!y COUNTY OF SAN JOAQUIN <br /> so. .co` OFFICE OF EMERGENCY SERVICES <br /> 2r 2101 E. Earhart Avenue,Suite 300 <br /> Q: <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> ORFax:(209)953-6268 <br /> F N`P <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSI ESS NAME ADDRESS(Facility Being Inspected) <br /> A Xva in c- CL <br /> ACCOUNT# START DATE(New Bus) INSPTTIODA ARRIVAL TIME DEPARTURE TIME INSPECTOR NAME <br /> 936 �s a lose o <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> . 1.HMMP/Map On Hand and Easily Accessible V 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 Accurate9. Hazardous Materials/Waste 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 /> dad d 0.4c�Ls s w; f o <br /> e v �sS / ✓0 CL, f 0. d c � ✓0 <br /> 4-1 <br /> INSPECTION FOLLOW UP INFOR TION <br /> orrective Actions q Additional <br /> o Be Submitted By: ZOO / Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usmess Representative(Print Name and Title) Busme epresentative Si e) <br /> WHITE COPY: OES <br /> �7-'QUP /7`O�/teaJ PINK COPY: BUSINESS <br /> REV 12/08 <br />