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0 0 <br /> o��ul0 COUNTY OF SAN JOAQUIN <br /> ?•'� ' o� OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> �y'•. .P Fax:(209)953-6268 <br /> �iFpR� <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSI S NA ADDRESS(Facility Being Inspected) <br /> G �i. in /e6 <br /> ACCOUNT# ISTART DATE(New Bus) INSPECTION DATE JARRIVALTIME DEPARTURE TIME INSPECTOR NAME <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 S6.S- fie) <br /> 2.Business Identification Page Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals Vr / 9 <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP S6 ,6p <br /> 4.Chemical Description Pages Complete and Accurate Sej Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available l0. Conditions that would hinder implementation of <br /> 171Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> rel` /tf9y eS uiG GG xr Z-'y0'10!d v��u- ��t sow.►�i acc� cri <br /> 1140 0,-A <br /> /Z.cr� Ale. <br /> S�ldGIG>�� �c�Gf/sd �� J�•,.�c5✓/�lld`d o� .tel P�d �p �r�.G <br /> /1! — //���Y9.�� .,.*✓G�.vl� No .ri./sr�� AG6 A.0 <br /> �6 h�Yl��� Ce+x-rib�.t�e✓� �o,�/ /�ce�l��6 �B6d/ �,toc��/�dd`t <br /> �L6'l1�6y✓ e�iP i'l0 <br /> y <br /> �i�6 did f/6� /•.i A (�E61�/GAZ� <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: �7 IU Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title)ITBusiness Representative(Signature) �yI{ITE COPY: OES_ PINK COPY: BUSINESS <br /> M I Nt G f l REV 17!08 <br />