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�N COUNTY OF SAN JOAQUIN <br /> °:err coy OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> ` 222 EAST WEBER AVENUE �'2 <br /> 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 /> T a6; Ng <br /> BUSINESS ADDRESS(Facility Being spected) ZIP CODE <br /> FIRE DISTRICT INSPEC ON DATE <br /> ARRRIAL TIME DEPARTURE TIME INSPECTOR NAMEIAGENCY <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 ✓ 8. Employees Familiar with HMMP Y <br /> 4: HMMP/Map Easily Accessible to Employees W-1 9.Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Available <br /> 10.Conditions noted that could increase risk of release <br /> A or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS A COMMENTS <br /> � �- c <br /> Cd <br /> NOTE: All HMMP documents except for the Facility Map can be created and updated on the San Joaquin Count) <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 /> f (if appropriate) ❑SJ Ag ❑SJ Env Hlth OSHA [:]Fire [:] Air Dist <br /> � � 2-0©fir ❑ <br /> ACKNOWLE GEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) f7;ReprMati7v7ature) <br /> PINK COPY: 2BU <br />