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saga c�� COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> m 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> �'��iko"N�asp• Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM '15— 2 d 2 <br /> B I S N ADDRESS(Facility Being Inspected) <br /> � .w , A VA T.e- C_ 1. sla F . N.t : .ti �� <br /> ACCOUNT START DATE(New Bus) INSP IO DATE ARRIVAL TIME DEPARTURE TIMEII SPEOR DAME <br /> ILOEF <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 L <br /> 2.Business Identification Page Com pl &Accurate 7. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical DescriptionP es Complete and Accurate 9. Hazardous Materials/Waste Pro y Labelled <br /> 5.Training Records Available 10. Conditions that would_bkffier implementation of <br /> Emergency Plan ori rease risk of release are absent <br /> EXPLANATIONOF <br /> �FINDINGS AND COMMENTS 1 <br /> � �Q✓�- 1Lr <br /> ('vacwc�T : Uc1 arstwb � a✓ pct � � Jt � xTi ✓l cr _ <br /> r /d l: s 0 IQ SII co1., k aI nil �.e�� � c-�f <br /> ✓b 2 Adl I � 'F o c-: A.2✓` s � <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective ActionsAdditional <br /> To Be Submitted By: A t/-: I 9 20 l O Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative int Name and Title) Business Representative(Signature) <br /> PWH�OPYY: BUSINESS <br /> REV 1 <br />