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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> Q 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> ��Cico'a'`'s'• Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> �S t _ Z�sy W ACC4Y IA 5,, 07 <br /> ACCOUNTli START DATE(New Bus) INSPECrIONDATE ARRIVALTIME DEPARTURETIME INSPECTORNAME <br /> 02 —TO <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate I/ 7. Presence of Non-Listed Regulated Chemicals t/ <br /> 3.Business HMMP Complete and Accurate keo" 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate V_*�' 9. Hazardous Materials/Waste Properly Labelled V <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 /> NSPECTION FOLLOW UP INFORMATION <br /> orrective Actions Additional <br /> o Be Submitted By: Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usmess Representative(Print Name and Title) Business Represe Si <br /> WHITE COPY: OES <br /> A a� x PINK COPY: BUSINESS <br /> C/n1V c..— ' 1 REV 12/08 <br />