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COUNTY OF SAN JOAQUI <br /> �a4A •coc OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> .• _ STOCKTON, CA 95202-2709 <br /> a��FOA� BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> 2p3 �z -3 <br /> BUSINESS ADDRESS(Facility Being Inspected) E <br /> FIRE DISTRICT MSPECTIONDATE ARRIVAL TIME IDEPARTURETRAE INSPECTOR NAME/AGENCY c f <br /> Ol f*? 1w,zool <br /> DOCUMENT REVIEW YES/NO FACILITY WALK THROUGH YF,S NO <br /> 1.Business HMMP Complete and Accurate 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 S. Employees Familiar with HMMP <br /> 4.HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Available 10.Conditions noted that could increase risk of releas <br /> or hinder implementation of emergency lan <br /> EXPL_1NATION OF FINDINGS AND COMMENTS a <br /> Js��rs.�.eE' /s D /,i�.r,iY 3 zo D C✓/��.. S� �,c�.i1/��r U.}/6 ,c.p <br /> efi D i! .r,®D4ics ,aa A ZEB �ibs/ �A sin/ <br /> o� e <br /> �- �/�- <br /> 46 <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 /> (if appropriate) ❑SJ Ag ❑SJ Env Hlth [_]OSHA ❑Fire ❑ Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Sign re) <br /> WHITE COPY: 4/07 <br /> PINKCOPY: BUS. <br />