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I! <br /> YY II PIS <br /> pQUf1y COUNTY OF SAN JOAQUIN <br /> �o. .coG OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue, Suite 300 <br /> Stockton, California 95206 <br /> = Telephone: (209)953-6200 <br /> cd�ii oai'`� Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME / ADDRESS(Facility Being Inspected) i <br /> wa E �CX,t G .w � <br /> ACCOUNT# START DA ew us) INSPECTION DATE I ARRIVAL TME EPARTURE TIME INSP CT R NAME <br /> X 5- JD <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES O FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accur�te <br /> 2.Business Identification Page Complete&Accurate 7. Presence of Non-Listed RegulatedChemicals <br /> A: <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 /> IF <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 /> i� <br /> I <br /> l <br /> Ot/ d t>es-.e L -A_�5k <br /> J� <br /> I <br /> I� <br /> a <br /> a <br /> i <br /> J <br /> !I <br /> 1� <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> o Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS !� <br /> Business esentative(P int Name and Title) Business re. tati i ture) f <br /> 9 WHITE COPY: QES <br /> PINK COPY: BUSINESS <br /> REV 12108 <br />