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FEE <br />F1 <br />COUNTY OF SAN JOAQUIN <br />OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE / 7C <br />`- STOCKTON, CA 95202-2709 <br />BUS. (209) 468-3969 FAX (209) 468-0273 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br />BUSINESS NA // <br />d�f�, <br />A T4/ 7-111 A <br />TELEPHONE NUMBER <br />02s S80K�12 <br />BUSINESS ADDRESS (Facility Being lnspecte� <br />4., - r' <br />+3 <br />ZIPPCODE <br />-2 <br />FIRE DISTRICT <br />,,, 1, <br />INSP ION A.TEIVALTINIE <br />— <br />JA121 <br />DEPARTURE TINIE <br />12-40 <br />INSPECTOR NAMEIAGENCY <br />DOCUMENT REVIE YES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP Complete and Accurate <br />✓ <br />6. Facility Map Complete and Accurate <br />2. Chemical Description Pages Complete and Accurate <br />7. Chemical Inventory Complete and Accurate <br />3. Business Identification Page Complete and Accurate <br />8. Employees Familiar with HMMP <br />.4. HMMP/Map Easily Accessible to Employees <br />r/ <br />9. Hazardous Materials/Waste Properly Labelled <br />5. Training/Exercise Records Available/1% <br />i A <br />10. Conditions noted that could increase risk of release <br />I or hinder im lementation of emergency lan <br />EXPLANATION OF FINDINGS AND COMMENTS <br />CO <br />d C1 <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 <br />.--� <br />Follow -Up Inspection Date <br />(if appropriate) <br />Referral Actions <br />SJ Ag [:] SJ Env Hlth OSHA [:] Fire ❑ Air Dist <br />kCKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative (Print Name and Title) <br />�. <br />Business Representative (Signature) <br />WHITE COPYJBUS. <br />PINK COPY:C <br />MA <br />