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Pq�,N COUNTY OF SAN JOAQUI <br /> OFFICE OF EMERGENCY SERVICES <br /> ?� ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS ME HONE NUMBER <br /> ' -7ql 2 <br /> BUSINESS ADD SS(Facility ei g In cted) Z CODED <br /> FIRE DISTRICT INSPECTIONDATE ARRIVALTIME I DEPARTURE TIME IN TO NAMFIAGENCY <br /> DOCUMENT REVIEW • YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate 8.Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Available 10.Conditions noted that could increase risk of releas <br /> or hinder implementation of e ergency plan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> NOTE: All HMMP documents except for the Facility Map can be created and updated on the San Joaquin County <br /> IIMMP Compliance Website at www.sjoesdata.org. Contact OES for user name and password. <br /> INSPECTION FOLLOW-UP INFORMATION <br /> Corrective Actions Must Be Submitted By Follow-Up Inspection Date Referral Actions <br /> (if appropriate) ❑SJ Ag E]SJ Env Hlth ❑OSHA ❑Fire ❑ Air Dist <br /> ID <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Repre the(Sign ure) <br /> A <br /> WHITE COPY: OPS <br /> PINKCOPY: BUS. <br /> h r%4 "" am <br /> 9 <br />