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�oaaq!r. COUNTY OF SAN JOAQUIN <br /> .o <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> i+A'• Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> B INESS NAE ADDRESS(Facility Bein nspected) <br /> 99 <br /> ACCOUNT# STAR AT (New Bus) INSPECTION DATE ARRIV�TIME DE AR URE TIME I SP O NA E <br /> o -o -01 NO % d <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 7. Presence of Non-Listed Regulated Chemicals <br /> 3. Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 10. Conditions[hat would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> 1—?o-09 <br /> NSPECTION FOLLOW UP INFORMATION <br /> orrective ActionsAdditional <br /> o Be Submitted By: 2 Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usmess Representative(Print Name and Title) Business Representative(Signature) <br /> WHrfE COPY: OFS <br /> A b �} PINK COPY: BUSINESS <br /> Lem Rev twos <br />