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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ? ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE / 7 70 <br /> - �... _...;T STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> a 6/ / 916 - 28 - zoo <br /> BUSINESS ADDRESS(Facility Being spected) ZIPCODE <br /> Al M4414 flu-76 <br /> FIRE DISTRICT INSP ON DATE ARRIVALTIME DEPARTURE TIME INSPECTORS AMEIAGENCY <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate t/ 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 t/ 8. Employees Familiar with HMMP <br /> 4'. HMMP/Map Easily Accessible to Employees W/ 9.Hazardous Materials/Waste Properly Labelled <br /> 10.Conditions noted that could increase risk of release <br /> 5.Training/Exercise Records Available �✓ or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS A COMMENTS <br /> c�' W��n s3Y iIIN B <br /> */ / 2 I II i0.. O <br /> eXF I.crL i / ct aT� <br /> NOTE: All HMMP documents except for the Facility Map can be created and updated on the San Joaquin County <br /> HMMP 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 /> Z0©F— (if appropriate) ❑SJ Ag ❑SJ Env Hlth [_]OSHA ❑Fire ❑ Air Dist <br /> TI( I <br /> CKNOWLE GEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) BRepr ativ ature) <br /> \ �`d C WHITE COPY: OPS <br /> ic, PINK COPY: BUS. <br /> 41 <br /> 1 4/07 <br /> I <br /> i <br />